64 year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit.
A. 99283-25, 12014, 12034-59, 12002-59, 11042-51
B. 99283-25, 12053, 12034-59, 12002-59
C. 99283-25, 12014, 12034-59, 11042-51
D. 99283-25, 12053, 12034-59
What I totally don’t understand is the rationale behind the answer. It states, "To start narrowing your choices down, the hand and foot were closed with adhesive strips. The Section Guidelines in the CPT® manual for Repair (Closure) states: Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code. Eliminating multiple choice answers A and B. The lacerations on the face are intermediate repairs, because debridement and glass debris was removed. The guidelines in the CPT® codebook for Repair (Closure) states: Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair. Eliminating multiple choice answer C. The intermediate repair of the lacerations to the face totaled 6 cm (12053). The right arm and left leg had cuts measuring 5 cm each which totaled 10 cm requiring intermediate repair (12034)."
The problem I have with this answer is that ALL of the answers have the same E/M code in the same place – so how can you use the rationale stated above (Guidelines… B)?