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WHEN BILLING FOR A COMPLEX LACERATION

Mary Posted Mon 12th of August, 2013 21:43:32 PM

OFFICE VISIT, COMPLEX LACERATION ,SUTURES, EM TIME,GAUSE WHAT DO WE BILL AND WHAT MODIFERS GO WITH WHAT ALSO INJECTION XYLOCAINE

Mary Posted Mon 12th of August, 2013 21:44:39 PM

I AM NEW WHAT ARE YOU ASKING FOR

Mary Posted Sun 18th of August, 2013 12:54:24 PM

My question is a child comes in with a laceration it will take more time to repair please let me know how to bill an ov with 30 more minutes then comes gauze, suture. The problem I need to know what em time applies and what modifier for say needle a4206,gause,sutures.These modifers are confusing.

SuperCoder Answered Mon 19th of August, 2013 16:40:17 PM

Report an E/M service if chart documentation supports that it is separately identifiable from the laceration repair. A -25 modifier should go on the E/M. If the service takes significantly longer than normal because of the child’s age, this code can be reported with the prolonged services code, 99354, but I would not do so, since it is the procedure not the E/M that is requiring the extended time. Of note, the E/M must have required more than 30 minutes longer than the typical time published in CPT, for example, 30 minutes face-to-face time for code 99203, in order to report prolonged services. The correct complex laceration repair code will depend on the location and length of the repair required. Local anesthesia is included in the repair codes, so the xylocaine would not be separately reportable. The practice expense should be included in the procedure code for the office setting, so I’m confused about the question on modifier for supplies.

Mary Posted Fri 27th of September, 2013 17:15:24 PM

is there a modifier for supplies A4206 examp So in conclusion a young child comes in with a laceration I bill 99203 25 and 12002. Or is it 99354 25 with 12002. Lets give me a clear direction
Thank you

SuperCoder Answered Fri 27th of September, 2013 18:47:10 PM

Please be patient. We will answer this soon.

Thanks,

SuperCoder Answered Fri 27th of September, 2013 18:47:10 PM
With CE
SuperCoder Answered Sun 29th of September, 2013 23:35:37 PM

On the professional side the supplies are included in the code so not separately billable ad no modifier is needed. So Yes, report in the office the E/M code such as 99203 with the -25 and the appropriate laceration repair code such as 12001. The repair code will depend on the location and length of the repair in question and the E/M code will depend on eth history, physical exam and medical decision making documented.

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