Wiki Trixie2013

[Trixie2013]

We are a Family Practice office in a rural area and often our physician does in office procedures. Scenario: A Medicare patient comes in with a puncture wound to the hand. Physician examines, cleans and repairs the wound using dermabond; the patient also receives a tetanus shot. Is it appropriate to bill for an office visit (99213) or wound repair (12001) and include the G0168 per Medicare? Any insight would be greatly appreciated.

 

[danskangel313]

We are a Family Practice office in a rural area and often our physician does in office procedures. Scenario: A Medicare patient comes in with a puncture wound to the hand. Physician examines, cleans and repairs the wound using dermabond; the patient also receives a tetanus shot. Is it appropriate to bill for an office visit (99213) or wound repair (12001) and include the G0168 per Medicare? Any insight would be greatly appreciated.

12001 includes the closure (tissue adhesives, staples, or suture materials), however Medicare pays for the supply G0168. This only applies if the dermabond is the sole method of closure; you can't have sutures and dermabond if you want to bill G0168. Not all payers will reimburse for this code.

As far as the E/M charge, you can only bill for it if the physician has to do work above and beyond what would normally be done to repair the wound. If you meet that criteria, you would bill 99213-25, 12001 (and G0168).

The tetanus shot will only be paid by Medicare if the patient has an injury that requires it, such as the patient stepping on a rusty nail. Don't forget to report the charges for that as well as the appropriate DX(s).