Billing lacerations can be tricky. Follow these steps to arrive at the appropriate number of calls.
Remember the 3 L’S: Length, Location and Layers.
Length and Location
For total lengths that are over any unit by any amount, round up to the next unit.
- Facial lacerations = 2.5 cm per unit (ears, under jaw bone and hair line forward is considered the face).
- Body lacerations = 5.0 cm per unit (remainder of body including scalp)
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Layers
For multiple layered lacerations, measure and count each layer separately
Billing Steps
- Measure the total the length of all laceration(s).
- Convert the length into number of units using the above definitions.
- For facial lacerations less than 2.5cm or body less than 5cm, use 98.22A.
- Any lengths over those stated in 3 above, use 98.22B with the number of calls equal to the number of total units (regardless of location).
Examples
- A patient has a small laceration, one layer on the cheek that is 2.3 cm.
- A patient has a double layer laceration on the cheek 2.5 cm long each layer.
- A patient has two lacerations: a leg laceration with two layers (superficial layer 10 cm, deep layer 5 cm), and a 2.5 cm facial laceration.
- Bill 98.22B 4 units – 3 units for the leg lacerations (layer one 2 units, layer two 1 unit); face laceration 1 unit.
98.22A Laceration, face, up to 2.5 cm (1 unit) or body, up to 5 cm (1 unit) NOTE: See 98.22B for lacerations exceeding the lengths listed above.
98.22B Laceration, face, over 2.5 cm (1 unit) and/or body, over 5 cm (1 unit). For each layer or unit, refer to Price List
NOTE: The following applies to HSCs 98.22A and 98.22B.
- Benefit includes primary closure of wound by any method excluding adhesive tape skin closure or simple bandaging, normal wound care follow-up and suture removal.
- Where the laceration is treated with the use of adhesive tape skin closure or simple bandaging, a visit should be claimed.
- Where multiple lacerations are repaired, use the combined length.
