1. Understanding How to Document Lacerations
Larry Halem, MD, CPC
VEP Regional Productivity Director

2. E+M reference guide Level 1 (99281): 0.6 RVU Level 2 (99282): 1.17 RVU

3. Lacerations Laceration are broken down by location
Body Area 1: scalp, neck, axillae, external genitalia, trunk, and extremities
Body Area 2: face, ears, eyelids, nose, lips and/or mucous membranes
These are the 2 main areas but be specific as this can greatly affect how the laceration codes

4. Lacerations
Lacerations are broken down by complexity of the laceration
Simple: single layer closure
Intermediate:
multiple layer closure that involves simple trimming or debridement
Single layer closure requiring extensive cleaning or removal of foreign bodies
Complex:
Creation of new wound margins with excision of old wound
Extensive undermining
Scar revision

5. Lacerations
If you have multiple lacerations in the same body area and the same complexity, these lacerations length will be added together
Example: Patient has a 3 cm simple laceration to the right hand, a 5 cm simple laceration to the left leg, and a 2 cm simple laceration to the face (total length in body area 1 is 8 cm and total length in body area 2 is 2 cm)

6. Lacerations Why is this important?
For patients with large and multiple lacerations there are upper limits of billing within each area
Maximum length that can be billed is over 30 cm per body area
However, each body area can be billed up to over 30 cm each for simple, intermediate, and complex
Example: Patient has a 32 cm simple closure leg laceration and a 3 cm intermediate closure right arm laceration (Even though they are in the same body area, and we have exceeded 30 cm for the leg, the arm repair will still code because it is a different complexity

7. Lacerations Simple body area 1 2.5 cm or less: 1.27 2.6-7.5 cm: 1.68
Over 30cm: 4.21

8. Lacerations Simple body area 2 2.5 cm or less: 1.58 2.6-5 cm: 1.66
Over 30 cm: 5.07

9. Lacerations
Intermediate Body area 1: scalp, axillae, trunk, and extremities
***Hands, feet, neck and genitalia separated ()
2.5 cm or less: 4.41 (4.44)
cm: 5.62 (5.79)
cm: 5.98 (6.19)
cm: 6.91 (7.76)
cm: 8.03 (8.9)
Over 30cm: 9.47 (10.64)

10. Lacerations
Intermediate body area 2: face, ears, eyelids, nose, lips and/or mucous membranes
2.5 cm or less: 4.94
2.6-5 cm: 5.89
cm: 6.28
cm: 6.41
cm: 8.79
cm: 9.85
Over 30 cm: 11.28

11. Lacerations Complex lacerations: Trunk Scalp, extremities
cm: 5.9
cm: 7.32
each additional 5 cm: 2.15
Scalp, extremities
cm: 6.82
cm: 7.73
Each additional 5 cm: 2.48

12. Lacerations Complex lacerations:
Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet
cm: 7.23
cm: 9.11
Each additional 5 cm: 3.81
Eyelids, nose, ear, lips
cm: 8.31
cm: 10.1
Each additional 5 cm: 4.1

13. Tissue Adhesives
Laceration
Repair with tissue adhesive: 0.8

14. Lip laceration: special considerations
If wound is a full thickness injury: through and through
Repair of full thickness; vermilion border only: 8.63
Repair lip full thickness; up to half of vertical height: 10.23
Repair of lip, full thickness; over ½ of vertical height or complex: 12.34
Note: superficial laceration of lip even if it involves vermilion
2.5 cm or less: 1.58

15. Mouth lacerations
Vestibule of mouth: area between teeth and lips and cheek
2.5 cm or less: 4.85
Over 2.5 cm : 6.58
Tongue lacerations:
2.5 cm or less: 5.27
Over 2.5 cm: 6.15