tci ED Coding & Reimbursement Alert - 2004 Issue 12

Reader Question: Consider Payer for Lip Repair Code

Consider Payer for Lip Repair Code Question: A patient had a through-and-through lip laceration. The physician's documentation supports simple closure with three nylon sutures for the outer lip (1 cm) and seven catgut sutures for the intraoral repair (2.5 cm). Should I report an intermediate repair with 12052, or a simple repair of the outer layer with 12011 and then 40830-51 for the intraoral one-layer closure?Virginia Subscriber Answer: Both scenarios are reasonable, depending on the physician's documentation. Additionally, if the vermillion border was involved, you might consider 40652 (Repair lip, full thickness; up to half vertical height)...

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