tci ED Coding & Reimbursement Alert - 2003 Issue 4

Clean Up Simple Laceration Claims and Get the Payment You Deserve

Simple laceration repairs may be relatively easy for your ED physicians, but they're far from simple to code. Here is in-depth advice on how to ensure your claims for simple laceration repairs (12001-12004, 12011 and 12013) receive proper reimbursement from payers. The contaminating problem for these codes may not be the laceration code at all. E/M codes and 99025 (Initial [new patient] visit when starred [*] surgical procedure constitutes major service at that visit) are commonly the reasons why some payers reject these claims, even though 12001-12004, 12011 and 12013 are starred procedures. Starred procedures cover only the procedure...

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