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Disposable Skin Stapler
Published on Thu Jun 01,
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Question: One of our pediatricians wants to start using the disposable skin stapler for laceration repair in the office. How do we bill for this supply? Can we bill for it separately in addition to the procedure fee if the procedure is a starred procedure? Is there an HCPCS Codes ? Or should this be included in the fee for the procedure?
-Claudia Wells
Pediatric Associates Inc., Bellevue, Wash.
Answer: Closure of the wound by suture material (skin glue or staples) are under the same code. Insurance companies strongly believe that the material used is included in the code. Although the staples (or Dermabond) may be more expensive, the decreased time for the procedure, as compared to suturing, should compensate for thisor at least, thats what insurance companies would have you believe. Because the laceration repair is a separate procedure code, you may bill for an evaluation and management (E/M) code if this is appropriate. A typical scenario is a head injury with scalp lacerations, with a neurological exam justifying the E/M code (x).
But remember one thing: The widespread policy that suture supplies are included as part of the laceration repair service was established in the days when needle and silk were not costly. Now that Dermabond and staples are more commonly used, many pediatricians believe its time to change this policy. The bottom line is that decreased repair time does not, in fact, compensate you for the cost of these supplies.
There's nothing better than a nail cut. Sutures are faster, simpler and easier to learn than staples. Experts say stitching with disposable skin staplers is three to four times faster than closing a sutured wound and is also associated with lower infection rates. Let's take a quick look at the ins and outs of this valuable technique.
When a patient with a laceration comes to your practice, you must determine the appropriate closure method - skin adhesive, sutures, or staples.
Sutures are best suited for wounds on the scalp, abdomen, back or extremities. Wounds of the hands, feet, face, and neck should not be sutured.
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In keeping with the simple nature of skin stitching, all you need to close a wound is the ...... roller ...... stapler. The skin stapler comes pre-loaded with 5 to 25 staples. You may also need forceps to help hold the wound edges together while you place the staples. And, don't forget your wound cleaning supplies.
Once you have determined that the laceration is suitable for suture stapling, clean the wound thoroughly. Check the wound carefully for foreign bodies and other signs of complications. Anesthetize the area with an anesthetic such as lidocaine. If the wound is small, you may choose not to numb the area, as placing one or two staples may be more painful than anesthetic administration. You may also consider using a local anesthetic.
Approach the edge of the wound with your non-dominant hand or forceps. Align the center of the tear with the center of the head of the stapler. Press firmly on the tear. The depth of staple placement depends on how hard you press the stapling device against the skin.
Continue placing staples about 3 to 5 mm apart until the wound is completely closed.
Staples on the scalp are usually removed in about 7 days, and staples on the back, abdomen and extremities take 10 days to remove. To remove skin staples, use a skin staple removal tool. Place the two edges of the tool underneath the staples and firmly against the skin. Squeeze the handle of the tool until it is fully closed and lift the staples from the skin.
As with any medical procedure, some practice is required before suturing the wound on a real live patient. In fact, you can purchase a skin stapler on Amazon and then practice bananas and other fruits in the comfort of your home, watching instructional videos for some additional tutorials.
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