Q: How do you code for a through and through lip laceration when the mucosa, subcutaneous tissue, and skin are all repaired? Can you report code 40650 with a code for the skin repair?
A: Assign only code 40650 for repair of a through and through lip laceration. This code includes repair of the mucosa, submucosa, and subcutaneous tissue. It would not be appropriate to assign a code for skin repair in addition to this. This question was addressed in Coding Clinic for HCPCS in Second Quarter 2004, page 12.
Q: Why is the percentage of body surface used for adjacent tissue transfer/rearrangement in infants and children? Why are they different than adults?
A: Infants’ and children’s heads are proportionately larger than the rest of their body than adults. And since infants and children are smaller than adults, using percentage of body surface is a better way of indicating how large the covered defect was.
Q: How is body surface area calculated in an infant or child? Should this be documented?
A: Body surface area is calculated using the Rule of Nines, which is often used to estimate total affected body surface area in burn patients. The percentage of body surface covered by an adjacent tissue transfer or rearrangement should be documented by the surgeon, but the Rule of Nines can be used as the basis of a query. The Rule of Nines is different in adults than babies or children, so it is important to refer to the correct rule. The Rule of Nines is a standard measurement that can be accessed by simple Google search. The AMA’s CPT Professional book also has this information along with a table according to patient age.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.