E/M and Repair on Laceration Claims

Let’s say an otherwise healthy man reports to the ED with lacerated index and middle fingers on the palmar surface, but there is no significant bleeding. The patient cut himself on a table saw. There is a 1.5cm jagged laceration with protruding fat located on the pad of the distal phalanx of both fingers. The physician uses Marcaine to apply digital blocks to both fingers, explores the wounds and finds no foreign bodies, and then closes the wounds.

This encounter should be coded with a pair of E codes, in order to identify the cause of injury. Report this claim as follows:

Report 12002 for the wound closure (this is for a simple repair of superficial wounds 2.6cm to 7.5 cm)

Report 99283 for the E/M service (this is for ED visit for evaluation and management) to show that the E/M and the wound closure were in fact separate services

Append modifier 25 to 12002 and to 99283 to represent the cut fingers (this is for significantly, separately identifiable evaluation and management on the same day)

Attach 993.0 to 12002 and to 99283 to represent the patient’s cut fingers.

Attach E919.4 to 12002 and to 99283 to represent the cause of the patient’s injuries (this code is for accidents caused by machinery; woodworking and forming machines).

Attach E849.3 to 12002 and to 99283 to represent the location of the accident (which was, in this case, at the patient’s place of work. This E code is for industrial place and premises).

View all Articles by: Kathryn Etienne, CCS-P