Welcome Spring With 3 Laceration Coding Scenarios

power up your laceration coding

The weather is getting warm enough for bare feet, knees, and elbows, and that leaves them more vulnerable to lacerations. Check out these three scenarios to help you choose correct codes for those cuts, powering up your laceration coding skills for spring.

Case 1: Don’t Overcode for Bandaging Skinned Knee

Suppose an established patient presents to the pediatrician with a skinned right knee. The provider examines the knee, cleans it with warm soapy water, and applies gauze and sterilized bandages.

Should you report a simple repair, an E/M code, or both?

In this case, you should use an E/M code to cover the complete service. Generally, if the provider uses adhesive strips or bandaging, then the E/M code will be sufficient to cover what the provider did.

Case 2: Know Payer Preference for Tissue Adhesive Repair

Now imagine a Medicare patient presenting to a family practice for a 2 cm scalp laceration. The provider uses a tissue adhesive for the repair.

Should you report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less)?

That code is a good choice except for one thing. Medicare accepts G0168 (Wound closure utilizing tissue adhesive(s) only). For other payers, 12001 may be appropriate.

Tip: In your manual or in your coding software, add a note with the CPT® laceration repair codes to remind yourself about G0168.

Case 3: Factor in Foreign Body Removal

In our final example, consider the coding for a patient who presents to the emergency department after stepping on a pile of branches and getting a puncture wound. The ED physician administers anesthesia, uses a blade to make an incision, explores the wound, and finds a foreign body extending into the deep tissues, including the fascia. The physician removes the foreign body and closes the wound.

Should you report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple)?

While 10120 does describe foreign body removal requiring incision. There’s a better option for this case: 28192 (Removal of foreign body, foot; deep).

If you caught the correct code, your wallet will be happy. Code 10120 pays about $105 in the facility setting, while the Medicare Physician Fee Schedule shows a national rate of $323 for 28192.

How About You?

What’s your best tip for how to ensure correct laceration repair coding? We didn’t go into ICD-10 codes here, but do you find diagnosis coding requirements for lacerations tough to take?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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