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Reader Questions: Laceration Repair and Debridement

Report 'Intermediate' For Glass Removal

Question: A 16-year-old male presented in the emergency department after crashing his bike and breaking a glass bottle that was in his pocket. He had a tear in his upper thigh. The physician performed a laceration repair, cleaning out lots of glass from the shattered bottle, and performed a layered closure. How should I report this?

Wyoming Subscriber

Answer: Report the appropriate code from the intermediate repair series for the extremities, 12031-12037. This laceration repair qualifies as intermediate -- a multilayered repair that involves simple trimming or debridement. (Complex repairs involve "extensive" debridement, which includes preparation of the wound.) Even if the repair were single-layered, you would report an intermediate repair because of the heavily contaminated wound that requires lots of time to clean out glass shards.

Take Your Pick for Fibroid Removal Coding

Question: The physician performed a hysteroscopy, dilation and curettage (D&C), and rectoscope with partial removal of a fibroid. How should I code this?

New York Subscriber

Answer: Although you may be tempted to report 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C), there are better options.

For example, you could bill 58561 (... with removal of leiomyomata). Or, depending on the amount of the fibroid the physician removed, you could choose 58561-52 (Reduced services) if the physician performed significantly less work than that described in 58561.

Report 64620 for Cryoneurolysis

Question: Which codes should I report for cryoneurolysis of the thoracic intercostal nerves at T9, T10, T11 and T12 under fluoroscopic guidance? 

Indiana Subscriber

Answer: You should code destruction of intercostal nerves with any neurolytic agent (including cold) with 64620 (Destruction by neurolytic agent, intercostal nerve). 

This code is for a single nerve and is unilateral. In the situation you describe, you would report multiple units if the physician destroys multiple intercostal nerves.

If the nerve destruction is closer to the spine (paravertebral facet joint nerves), use code 64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level) for the first level and use +64627 (... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]) for each additional level.

-- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C.