Coding Wound Repairs Is a Challenge for HIM Professionals
Susan Howe, ART, CCS
For the last year or so, health information management (HIM) professionals have been challenged by the need to determine a correct code assignment for tissue glue technique (Dermabond). In a recent issue of CPT™ Assistant (May 1999), the American Medical Association (AMA) clarified some of the confusion and explained how open wounds are closed using tissue glue technique.
The most common tissue glue is Dermabond–an adhesive used instead of sutures or staples. The advantage of this technique is that patients do not need to return to the physician for removal of the sutures or staples. (Note that adhesive strips, such as butterflies or steri-strips, are not considered adhesive glue technique and should not be reported as such.)
In the 1999 CPT code manual, no code descriptions exist for wound repair (simple, intermediate, complex) using adhesive glue technique. There is, however, a CPT code listed for reporting tissue glue technique when repairing wounds of the cornea and/or sclera. If you are coding this procedure and tissue glue technique was used, assign CPT code 65286 (repair of laceration; application of tissue glue, wounds of cornea or sclera).
The December 1998 CPT Assistant included a question from a reader regarding tissue glue technique and wounds closed by staples. Because the CPT coding manual does not have a specific coding description for these techniques, the AMA recommended that code 17999 (unlisted procedure, skin, mucous membrane and subcutaneous tissue) be used.
However, the AMA rescinded this advice in the May 1999 CPT Assistant. For services delivered in May 1999 and after, directed the AMA, assign codes from the wound repair section to designate closure utilizing tissue glue technique. The AMA has promised that changes will be made to the CPT 2000 coding manual to reflect the use of tissue glue technique in wound repair.
Back to Basics
In spite of all the confusion, though, be sure to adhere to the CPT coding guidelines for simple, intermediate and complex wound repair before assigning a CPT code for an encounter. Also remember the following definitions of these wound repairs, which can be found in the CPT manual.
* Simple Wound Repair. This superficial wound involves primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures; it requires simple, one layer closure/suturing. Usually, this code would be assigned when tissue glue technique is used to close a superficial wound.
* Intermediate Wound Repair. In addition to the above, this repair requires layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (nonmuscle) fascia, in addition to the skin (epidermal and dermal) closure. Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitute intermediate repair.
Coding Tip: Just because a physician states that he or she uses two types of suture material (absorbable and nonabsorbable) does not indicate performance of an intermediate repair. In the documentation, the physician must state that the wound was closed in layers.
* Complex Wound Repair. This repair of wounds requires more layered closure (scar revision, debridement, traumatic lacerations or avulsions, extensive undermining, stents or retention sutures). It may include defect creation and necessary repair preparations or debridement and repair of complicated lacerations or avulsions.
In addition to following the CPT manual guidelines, documentation also is key to appropriate CPT code assignment. Make sure physicians explain the wound repair method (e.g., tissue glue technique, simple, layer, etc.) and the length of wound closure. If this essential clinical information is not included, ask the physician about it before assigning a CPT code for wound repair.
The emergency room encounter presented below shows how tissue glue technique may be used and how to assign a code for it.
Subjective: A six-year-old female fell off her bicycle and injured her chin. This did not render her unconscious. She has no neck pain. She did abrade her left elbow.
Objective: Head, eyes, ears, nose and throat: Pupils are equal, round, regular and reactive to light and accommodation. There is a 3.1 cm, star-shaped, jagged, contaminated laceration present on the chin. The following are nontender: mandible, temporomandibular joints, neck and chest. Breath sounds: equal. Cardiac: no S3, S4 or murmurs. Abdomen: soft and non-tender. Extremities: some left elbow abrasions but no bony tenderness to suggest fracture. Patient has good range of motions. No distal neurovascular deficit.
Assessment: Chin laceration
Treatment: Lidocaine local was given, and the wound was debrided and revised for satisfactory closure. Dermabond was used to approximate the wound edges. The parents were instructed in wound care and advised to return if any signs of infections become evident. The patient is given an immediate dose of antibiotic and some Phenergan with Codeine for the pain from the debridement. Will be placed on antibiotic for the next few days.
Code Assignment and Rationale
12013 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm
Referring back to the AMA’s clarification (CPT Assistant, May 1999), assign the above code for the wound closure utilizing tissue glue technique. *
Susan Howe is a senior health care consultant with Medical Learning Inc., St. Paul, MN.
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