CPT Coding Guidelines — CPT Repair Code



CPT Coding Guidelines — CPT Repair Code http://www.cco.us/ceu-intro-cpt-coding-surgery-hcpsc-modifiers-class-yt

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?”

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.

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