Author Topic: Suture Removal  (Read 14109 times)

PMBS

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Suture Removal
« on: August 12, 2009, 09:25:33 AM »
Hi,

Does anyone know if Medicare pays for Suture Removals?  I used S0630 with modifier 55 but Medicare denied stating that the procedure code and modifer were invalid on the dos.  I have tried looking online but I can't find another code.  The provider who is removing the suture is not the same provider who did the sutures. 

Can we bill Medicare for this and if so do you know what code I could use?

Thanks

MR
MR

PMRNC

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Re: Suture Removal
« Reply #1 on: August 12, 2009, 09:46:16 AM »
Medicare considers the suture removal to be a part of the global period for the repair.

You can't use the S code, instead you will want to bill 12001  also with the modifier 55 However.. if the surgeon that repaired the laceration did not append 54 he's going to get full reimbursement for the global period, generally if the surgeon/physician that repaired the laceration assumes or directed the patient to return for suture removal they don't use the modifier 54.

Also make sure you use V58.3x as primary dx (Encounter for other and unspecified procedures and aftercare; attention to surgical dressings and sutures). your secondary will be the dx code that specifies the laceration’s site.

I BELIEVE..but I am NOT positive.. you can report low level E/M

Linda Walker
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Pay_My_Claims

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Re: Suture Removal
« Reply #2 on: August 12, 2009, 10:12:53 AM »

Steve Verno CMBS, CEMCS

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Re: Suture Removal
« Reply #3 on: August 13, 2009, 06:43:16 PM »
The following is from CPT regarding the surgical package:

The services provided by the physician to any patient by their very nature are variable. The CPT codes that represent a readily identifiable surgical procedure thereby include, on a procedure-by-procedure basis, a variety of services. In defining the specific services “included” in a given CPT surgical code, the following services are always included in addition to the operation per se:

bullet    Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia

bullet    Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physical)

bullet    Immediate postoperative care, including dictating operative notes, talking with the family and other physicians

bullet    Writing orders

bullet    Evaluating the patient in the postanesthesia recovery area

bullet    Typical postoperative follow-up care

Suture removal would be included with the surgical package. if the physician that put the sutures in and then removed them.  If Dr. A put the sutures in, in the emergency room and Dr. B, not of the emergency practice saw the patient for dressing changes and then suture removal, then the care by Dr. B is not part of the surgical package.  If Dr A did the wound checks, dressing changes and suture removal, then each subsequent visit during the global period.  The global period for surgical procedures is located in the RVU files at the CMS website.   
http://www.cms.hhs.gov/PhysicianFeeSched/pfsrvf/list.asp

When we billed for the wound checks in the emergency room where we put in the sutures, we billed a 99024 for each visit (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure).  If we didnt put in the sutures, we billed the appropriate 9928X level, usually a low level.  We used Modifier 24 with the 9928x.  Sometimes the insurance company denied as being in the global period.  That took a simple appeal with the records sent a second time as we attached a copy of the chart with the original claim.  We even got the claim back asking for the records and you can see where they tore off the chart from the claim form.  I would resend and put about 200 staples at  the top of the claim form.   IM not talking about the small, thin staples.  I used the heavy duty staples from the office supply store. The resend would go to the CEO.  That stopped record requests.

Sorry Charlene, I didnt see the article until i was done.  Good job and nice article.
« Last Edit: August 13, 2009, 06:48:45 PM by Coding4aliving »
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PMBS

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Re: Suture Removal
« Reply #4 on: August 16, 2009, 08:01:50 PM »
Thanks guys!
MR

MBP

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Re: Suture Removal
« Reply #5 on: September 23, 2009, 12:31:25 PM »
Coding for living,

how much did you charge for 99024? we use this cpt as internal cpt for $0.00 post op visit.. i dont see it on medicare fee schedule either. just curious, i bill for a surgeon and we have very many post ops - woundcare, suture removal, dressing changes etc..

thanks!!

Steve Verno CMBS, CEMCS

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Re: Suture Removal
« Reply #6 on: September 24, 2009, 03:12:18 PM »
99024 is a No charge visit, as it is services included in the surgical package, so we charged a whopping $0.00  No claim was sent. 
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
Left hand Blue, Right Leg Green
You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
I love spam.