Medical-grade tissue adhesives, also known as skin glues or surgical glues, are commonly employed in the emergency department to close wounds, surgical incisions, and lacerations.  It is an effective, non-invasive alternative to traditional sutures or staples and provides a quick and painless method of wound closure.

Tissue adhesives offer several advantages in the emergency department setting, including reduced closure time, elimination of the need for suture removal, and a barrier that resists microbial penetration. It also results in a cosmetically pleasing outcome, which is an important consideration for patients.

It’s important to note that while tissue adhesives are a versatile and highly useful tool, they are not suitable for every wound type. Deep wounds, bites, punctures, or wounds under high tension may require alternative closure methods.

ED coders must recognize when lacerations have been repaired with tissue adhesives instead of sutures or staples. The ED physician may use the brand name of the tissue adhesive in the procedure note. The most prevalent brands that are routinely utilized in healthcare facilities include:

• Dermabond (Ethicon) – A widely recognized brand, Dermabond is a topical skin adhesive often used in place of sutures for minor surgical incisions and lacerations. It contains 2-octyl cyanoacrylate, which provides strong, flexible bonds and has antibacterial properties.

• Histoacryl (B. Braun) – Known generically as butyl-2-cyanoacrylate, Histoacryl is another popular choice for tissue adhesion. It is used for the closure of simple, clean wounds and, in some cases, for the management of bleeding from minor vascular injuries.

• Indermil (Covidien) – Indermil is a cyanoacrylate-based tissue adhesive designed for the closure of surgical incisions and trauma-induced lacerations. It offers a quick and effective bonding solution that helps to minimize scarring.

• Leukosan Adhesive (B. Braun) – This adhesive is designed to provide fast and effective wound closure with good cosmetic results. It is another cyanoacrylate-based tissue adhesive that is suitable for a variety of clinical applications.

• GluStitch (GluStitch Inc.) – GluStitch is an octyl- and butyl-blend cyanoacrylate adhesive known for its versatility and strength in wound closure.

• LiquiBand (Advanced Medical Solutions) – LiquiBand is a range of cyanoacrylate-based tissue adhesives designed for wound closure and management. It is available in various formulations tailored to different clinical needs.

The coding for the application of tissue adhesives like Dermabond varies according to the insurance provider. For non-Medicare patients, lacerations repaired with tissue adhesives will be coded with the standard wound repair codes depending on the complexity of the wound: simple (12001-12021), intermediate (12031-12057), or complex (13100-13153).

CMS has expressed concern for the amount of work associated with Dermabond repairs compared to sutured wounds and created an HCPCS code that should be reported in lieu of CPT codes. For Medicare beneficiaries, HCPCS code G0168 should be reported for a wound repaired only using tissue adhesive. However, if tissue adhesives are used in conjunction with other closure methods, e.g., sutures or staples, the repair should be coded with the regular CPT codes for wound repair.