Learn how to code for laceration repair and suture removal.
Q: How do I code for laceration repair?
The codes within the simple and intermediate categories are further characterized by location of the injury. For instance, 12001–12007 refer to simple repairs on the scalp, neck, axillae, external genitalia, trunk, and/or extremities. Codes 12051–12057 describe intermediate repairs of wounds specifically to the face, ears, eyelids, nose, lips, and/or mucous membranes.
Once you've identified whether the repair is simple or intermediate and what part of the body was injured, note the length of the wound. Providers often forget to outline this detail in their reports.
You can code for all of them. When the patient has multiple lacerations of the same repair complexity on the same body part, coding is easy: You simply add the lengths of each wound together and choose the matching code.
For example, if a patient had a 5-cm cut near his left ankle and a 9-cm cut on his left calf, for a total of 14 cm, then use code 12005 (12.6 cm to 20.0 cm) for a simple repair and code 12035 for an intermediate repair.
Do not add up lengths from different anatomic sites (for instance, face and extremities). Bill each site individually, totaling repair lengths only within sites.
Q: How do I code for suture removal?
A: If a provider has placed sutures for a patient and the patient returns to the same provider for the suture removal, then the visit for the suture removal cannot be charged, because the removal is included in the initial laceration repair code.
If a different provider placed the sutures and the patient comes to your office for the removal, however, then an office visit evaluation and management (E/M) code can be billed.
The reasoning behind this determination is that, according to the American Medical Association: "There is not a separate code that describes removal of sutures when the removal is not performed under anesthesia. If the physician who removed the sutures did not place the sutures, then the suture removal would be considered part of [E/M]. Removal of sutures by the physician who originally placed them is not separately reportable."
If a provider places sutures initially, more will be paid for than just the laceration repair in most cases, because more is performed. For example, when a patient presents with a head laceration, an E/M would be charged with a diagnosis of head injury and modifier 25. A laceration repair code would be charged with the laceration diagnosis, making up for the no-charge follow-up visit.
Current Procedural Terminology lists 99211 as the code for removal of uncomplicated facial sutures in the appendix of clinical examples. The code 99213 is given as the example for removal of sutures in the hand. Your best guide for choosing a level is the same criteria you use otherwise: the work performed. Be sure to include documentation of healing or lack of healing as well as infection or lack of infection.
For ICD-9 billing, use V58.32, encounter for removal of sutures. If a problem is associated with the removal, however, then use a complication code (such as 998.59, postoperative infection).
The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky. Do you have a primary care-related coding question for our experts? Send it to firstname.lastname@example.org