For the last year or so, health indevelopment monitoring (HIM) specialists have actually been challenged by the need to determine a correct code assignment for tworry glue technique (Dermabond). In a current concern of CPT™ Assistant (May 1999), the American Medical Association (AMA) clarified some of the confusion and also described exactly how open up wounds are closed using tworry glue strategy.
The a lot of prevalent tworry glue is Dermabond–an adhesive provided instead of sutures or staples. The advantage of this technique is that patients execute not need to return to the physician for removal of the sutures or staples. (Keep in mind that adhesive strips, such as butterflies or steri-strips, are not considered adhesive glue strategy and have to not be reported as such.)
In the 1999 CPT code hand-operated, no code descriptions exist for wound repair (easy, intermediate, complex) using adhesive glue technique. Tbelow is, but, a CPT code noted for reporting tproblem glue method once repairing wounds of the cornea and/or sclera. If you are coding this procedure and tconcern glue method was offered, asauthorize CPT code 65286 (repair of laceration; application of tproblem glue, wounds of cornea or sclera).
The December 1998 CPT Assistant had a question from a reader regarding tconcern glue method and also wounds closed by staples. Since the CPT coding hand-operated does not have a specific coding summary for these techniques, the AMA recommfinished that code 17999 (unlisted procedure, skin, mucous membrane and also subcutaneous tissue) be supplied.
However before, the AMA rescinded this advice in the May 1999 CPT Assistant. For solutions yielded in May 1999 and after, directed the AMA, asauthorize codes from the wound repair section to designate closure utilizing tconcern glue approach. The AMA has promised that transforms will be made to the CPT 2000 coding hand-operated to reflect the use of tissue glue method in wound repair.
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Back to Basics
Despite all the confusion, though, be sure to adright here to the CPT coding guidelines for easy, intermediate and facility wound repair prior to assigning a CPT code for an enrespond to. Also remember the complying with meanings of these wound repairs, which deserve to be uncovered in the CPT manual.
* Simple Wound Repair. This superficial wound involves generally epidermis or dermis, or subcutaneous tworries without considerable involvement of deeper structures; it requires easy, one layer closure/suturing. Normally, this code would be assigned once tworry glue strategy is used to cshed a superficial wound.
* Intermediate Wound Repair. In addition to the above, this repair needs layered closure of one or more of the deeper layers of subcutaneous tissue and also superficial (nonmuscle) fascia, in enhancement to the skin (epidermal and also dermal) closure. Single-layer closure of greatly contaminated wounds that have actually compelled substantial cleaning or removal of particulate issue also constitute intermediate repair.
Coding Tip: Just because a physician states that he or she offers 2 kinds of suture product (absorbable and nonabsorbable) does not suggest performance of an intermediate repair. In the documentation, the doctor need to state that the wound was closed in layers.
* Complex Wound Repair. This repair of wounds needs even more layered clocertain (scar revision, debridement, traumatic lacerations or avulsions, considerable undermining, stents or retention sutures). It might encompass defect creation and essential repair preparations or debridement and repair of facility lacerations or avulsions.
In enhancement to complying with the CPT manual guidelines, documentation additionally is essential to correct CPT code assignment. Make certain doctors explain the wound repair technique (e.g., tissue glue method, basic, layer, etc.) and the size of wound closure. If this crucial clinical information is not included, ask the physician about it prior to assigning a CPT code for wound repair.
The emergency room enrespond to presented below mirrors how tconcern glue method 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 actually no neck pain. She did abrade her left elbow.
Objective: Head, eyes, ears, nose and also throat: Pupils are equal, round, continual and reactive to light and accommodation. Tright here is a 3.1 cm, star-shaped, jagged, contaminated laceration existing on the chin. The complying with 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 however no bony tenderness to suggest fracture. Patient has actually great array of motions. No distal neurovascular deficit.
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Assessment: Chin laceration
Treatment: Lidocaine local was given, and also 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 also advised to rerevolve if any type of signs of infections become noticeable. The patient is offered an instant dose of antibiotic and some Phenergan through 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 earlier to the AMA’s clarification (CPT Assistant, May 1999), assign the above code for the wound closure utilizing tproblem glue technique. *
Susan Howe is a senior health care consultant via Medical Learning Inc., St. Paul, MN.