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Quiz yourself on coding multiple laceration repairs

HCPro Coder Connection, April 20, 2005

Quiz yourself on coding multiple laceration repairs

Can you code multiple laceration repairs performed in the ED for the physician and facility side? Read the below case study and test yourself.

A patient presents to Apex Medical Center's ED after a car accident. Although there are no life-threatening conditions, the individual has the following injuries:

  • 4.2 cm laceration on the right forearm, requiring layered closure
  • 6.0 cm laceration on the left forearm, requiring extensive cleaning and debridement of particulate matter, although only a simple repair is required
  • 3.0 cm laceration on the forehead, requiring layered closure
  • 4.0 cm laceration on the face, requiring layered closure

An ED physician repairs the first three lacerations, and the ED calls a dermatologist to repair the fourth laceration. What physician and facility codes should you use?

The coding
The case is not unusual and it illustrates the complexities involved in coding and billing in this area.

The emergency physician will code for the first three lacerations. The first laceration is an intermediate closure with CPT 12032. The second laceration is a simple repair, but there is debridement, so this is elevated to an intermediate repair with CPT 12032. Now, however, both laceration repairs are of the same type or level in the same anatomical area (according to the CPT code classification) so the lengths of the two lacerations must be added to give an intermediate repair of length 10.2 cm, with CPT 12034. The emergency physician will code the forehead laceration as CPT 12052, and the dermatologist will file a claim for the laceration on the face (CPT 12052).

On the hospital side, the coding is essentially the same, except we have a concern with the two laceration repairs to the forehead and the face. Certainly CPT 12034 will be used for the laceration repairs on the extremities. Because the hospital is filing a claim for services provided, regardless of which or how many providers render services, the two lacerations (one to the forehead and one to the face) are of the same type and in the same anatomical area, so the hospital must add these lengths to obtain 7.0 cm (i.e., CPT 12053).

Of course, everyone should check whether there is any need to use modifier -59 on either the emergency physician (professional) claim or the hospital (technical) claim (i.e., check for any CCI edit violations).

(This article was excerpted from HCPro, Inc.'s new book, Emergency Department Coding and Billing: A Guide to Reimbursement and Compliance, written by Duane C. Abbey, Ph.D., CFP. For more information or to order, go to www.hcmarketplace.com or call 877/727-1728).