tci ED Coding & Reimbursement Alert - 2009 Issue 5

You Be the Coder: Repair Coding and Mouth Injuries

Question: A patient with a laceration on the inside of her mouth reports to the ED; the wound is bleeding, but a level-two E/M reveals that the cut is entirely inside the patient's mouth. The nurse practitioner (NP) stops the bleeding with gauze and some light pressure. Then the ED physician closes the 2.3-cm cut using sutures. We reported 12011 and our internal compliance office questioned the code. Why? Minnesota SubscriberAnswer: This is an example where you can measure the coding in degrees of accuracy. While the mucous membrane repair descriptor is not fully incorrect, there is a...

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