Laceration Medical Billing Claims Made Easy

Lacerations are a common occurrence in the ED and knowing the in’s and out’s of medical billing for these types of claims will make filing each and every single one of them a breeze.

For example if you have a patient that presents who was using a table saw on the job and lacerated index and middle fingers on the palmar surface, but there is no significant bleeding and he is otherwise healthy. How would you report this?
On further examination the physician finds on the pad of the distal phalanx of both involved fingers is a 1.5-cm laceration that is jagged with protruding fat. The notes read that the physician applies digital blocks to both fingers with Marcaine, explores the wounds for foreign bodies with none found and closes the wound.

In most cases, in order to realize the best reimbursement for this medical billing claim, you will need to use a pair of E codes. An example for standardly reporting this claim follows :
* report 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 wound closure.

* report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem- focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M service.

* append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99283 to show that the E/M and the wound closure were separate services.

* attach 883.0 (Open wound of finger[s]; without mention of complication) to 12002 and 99283 to represent the patient’s cut fingers.

* attach E919.4 (Accidents caused by machinery; woodworking and forming machines) to 12002 and 99283 to represent the external cause of the patient’s accident.

* attach E849.3 (Place of occurrence; industrial place and premises) to 12002 and 99283 to represent the location of the patient’s accident.

Just read the medical procedure notes logically and you’ll see quickly that this commonly performed procedure is actually very simple to compile for your medical billing claims.

View all Articles by: Kathryn Etienne, CCS-P