Warning: Your coding will vary depending on who’s getting the claim
Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During an expanded problem focused history and exam, the physician undresses the wound, applies pressure and ice to stop the bleeding, and cleans it using Betadine. During the E/M service, the physician notes a laceration to the index finger but no signs of infection. Using Dermabond, the physician closes a 2.7 cm laceration on the patient’s finger. How should I code this encounter?
Answer…It depends on the insurer; Medicare has its own rules regarding single-layer laceration repairs in which Dermabond is the only closure material. Here’s a look at how to code for Medicare and commercial carriers:
Medicare: Report the following:
• G0168 (Wound closure utilizing tissue adhesive[s] only) for the closure
• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity …) for the E/M
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/M and closure were separate services
• 883.0 (Open wound of finger[s]; without mention of complication) appended to G0168 and the E/M code to represent the patient’s injury
• E920.1 (Accidents caused by cutting and piercing instruments or objects; other powered hand tools) appended to G0168 and 99282 to represent the cause of the patient’s injury.
Private payers: Carriers that don’t follow Medicare’s lead will expect to see the following for the samescenario:
• 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) for the repair
• 99282-25 to show that the E/M and closure were separate services
• 883.0 and E920.1 appended to 12002 and 99282 code to represent the patient’s injury and the cause of the patient’s injury, respectively.
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