CPT Repair Code — VIDEO

So here comes a CPT question on repairs. This is from Linda. She said, “Hello. What is the correct CPT repair code for this? Is it a simple wound repair or 43870, or another code all together? What are the correct ICD-9 diagnosis codes? Also, what CPT  ED level charge would you use?”

CPT Repair Code – VIDEO

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Let me go to the answer sheet so that you can see it in context here. We’ve got an 80-year-old patient presenting to the emergency room from the nursing home with bleeding from the gastrostomy site. Remember, gastrostomy, “-ostomy” means an artificial opening, so they had probably a bag inserted there, so they have a gastrostomy site. The ER physician documents multiple minor skin tears around the stoma site. Stoma is just another word for that opening. The ER physician sutures the skin with 4.0 silk sutures. The patient has a history of hypertension, dysphagia – which is difficulty swallowing from an old CVA, and insulin requiring type-2 diabetes. The Triage nurse listed the patient current meds and they’re verified by the ED physician. So, she had suggested was 43870 which when you look it up is closure of a gastrostomy, surgically.

In this note that we read, it didn’t talk about closing it. It just talked about repairing it around the opening, so the opening had some skin tears. You can see they really kind of minimized it. You know they said “minor skin tears” and they just did sutures. It didn’t talk about they had to do layered sutures and da-da-da. It just talked about minor skin tears, did sutures. So, when you get into coding for the integumentary system, for the skin, you want to be looking for that. What was the location of it? In this case, around the gastrostomy. It’s going to be on your trunk, your abdomen area.

When you see skin sutures, you want to think of a repair. We’re talking about stitches. You know, I went to the ER and I have to have how many stitches. But when we start to become coders, we have to think about more medical terms and they call those repairs – simple, intermediate or complex repairs. Since this just said “minor skin tears” we’re going to consider it a simple repair. If it was a deep wound, then we would use an intermediate or complex repair. But this one was a simple one.

Now, with the integumentary system and repairs, we normally need to know how many stitches or what was the length of the repair? This documentation did not provide it, so we’re going to have to go with the lowest amount when we get into our CPT manual. I’m trying to take a scan of particular pages versus using my document camera so those in the Replay Club that are getting all of these handouts nicely done by Ruth can have these as an attachment.

Here you can see my manual up close exactly how I bubble and highlight and make notes for myself. I’m taking you to the repair codes and what you want to look at is, we’ve got “simple” is our first group. If you look at the first bubble, if you will, the first grouping, it’s simple and what’s the location? Scalp, neck, axilla, external genitalia, trunk and our extremities. So when I’m teaching this, I say, “Remember, it’s location, location, location. You got to get in the right bubble first.”

So, here’s this one and here’s that trunk that we were talking about. If we go over in the other side, we’ll see the second bubble for simple repairs. It’s just different location – face, eyes, eyelids, nose, lips and/or mucous membranes. So, we’ve got two bubbles for that. Then, it goes on and repeats the same pattern with intermediate repairs and with complex repairs.

So, your first job: Is it simple, intermediate or complex? We determined it’s simple. Then the second job is: What’s the location? And we determined it’s the trunk. Then, we need to know the measurements once we’re within that bubble. Since we weren’t provided with any, we have to go with the lower amount or query the physician. I don’t have the physician here to ask, so that brings us to 12001. That’s how my mind works how I would attack the coding for that. So, I would have gone to the index and look up repairs and it would have brought me to this page.

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