Hi Jay. Agree with all your points except the cumulative RVUs.
If I were to do this, I would still bill the laceration patient for the E&M code (99282 or 99283), I would just forego the procedure code for the laceration repair and move on to my next patient and bill that patient's E&M code. So the difference would be the procedure code versus the next patient's E&M code.
Agree that it's professionally fulfilling to do wound repairs.
James Chamberlain, MD
Division Chief, Emergency Medicine
Children’s National Medical Center
202.476.5433 (Emergency Access)
From: Jay Pershad [mailto:[log in to unmask]]
Sent: Monday, November 12, 2012 7:53 PM
To: [log in to unmask]; Chamberlain, Jim
Cc: Jay Pershad
Subject: Re: RN wound closure program
Interesting take as always. There were many confounding variables that we considered when wrestling with this decision.
1.A single layer uncomplicated laceration may be amenable to closure with tissue adhesive. The time involved is much shorter than suture repair.
2.A sizeable proportion of our wound management encounters occur during the warmer months when ADC of level 3's is traditionally lower.
3.Another variable is collections/RVU vary between payers in our region depending on type of service. For govt and non govt. payers, avg collection ratios are better for procedure codes.
4.Because injuries occur in the context of an E&M, most wound management encounters entail an E&M code and a laceration repair code -with 25 modifier. In your analysis, one would have to consider cumulative RVUs.
5.Some laceration repairs in our ED involve moderate sedation (99143 series of codes) with nitrous or IN fentanyl/midazolam or ketamine. This adds to the complexity of pediatric wound management.
6.As Jill mentioned, an intermediate or complex laceration repair, offers a level of professional satisfaction that influences our career choice of PEM's. Even in a simple repair in a toddler is a challenging encounter 7.In AHC's, it is a great teaching opportunity that our resident's do not experience in any other setting except the ED.
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