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  #1  
Old 08-17-2009, 09:43 AM
JCampbell JCampbell is offline
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Cool Suture Removal

Pt came in and the nurse removed the sutures. Sutures were put in by another office. Can our office bill a nurse visit for this since the dr did not remove the sutures?

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Old 08-17-2009, 10:04 AM
LLovett LLovett is offline
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As long as the note supports it yes you can.

If all it says is "suture removal" then no, that is not billable as a 99211. Even though it is low level and doesn't technically have defined key components, 99211 is still and E/M service. So you would have to have a chief complaint and documentation that supports an evaluation and management service was provided.

Laura, CPC, CEMC
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Old 08-17-2009, 11:08 AM
dballard2004 dballard2004 is offline
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I agree, but I would also note to append modifier 55 to the E/M code to indicate post management if it is a procedure that has a 10 day global. If it has a 0 day global, don't use the 55.
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Last edited by dballard2004; 08-17-2009 at 11:29 AM.
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Old 08-17-2009, 08:40 PM
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mitchellde mitchellde is offline
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The 55 modifier is appended to surgical codes it is not an E&M modifier. Your nurse may NOT remove sutures put in by another physician, your nurse may only follow orders by her physician. Also the sutures are global to the physician that put them in. If the repair has a 10 day global, then the physician that put them in either takes them out or transfers the care to you. If a transfer has occurred, you must document this in the chart, and put a note in box 19 of the 1500 to indicate a transfer of care, your physician must evaluate the patient and then either remove the sutures or he may pass it off to your nurse. The CPT code will not be an E&M it will be the same laceration repair code used in the ER with a 55 modifier. It is not pretty but that is the way it is to be done.
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Old 08-18-2009, 07:31 AM
LLovett LLovett is offline
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Debra,

Can you please give your source for this information?

This is not how I have ever handled this situation in any of the 3 states I have worked in. I can honestly say I have never had a transfer of care on sutures before. We had an elderly man a couple of weeks ago that didn't even know he had stitches until the doctor was examining him and told him they need to come out.

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Laura, CPC, CEMC
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Old 08-18-2009, 08:20 AM
RebeccaWoodward* RebeccaWoodward* is offline
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Q&A from CPT Assistant, Dec. 2002, on suture removal:

"If a physician removes sutures during an office visit that were originally placed by a different physician, how should the suture removal be reported?

AMA Comment: There is not a separate code that describes removal of sutures when the removal is not performed under anesthesia. If the physician who removed the sutures did not place the sutures, then the suture removal would be considered part of evaluation and management (E/M). Removal of sutures by the physician who originally placed them is not separately reportable."

Or)

Suture removal (American Academy of Family Physicians)

Q: What code should I use for in-office removal of sutures placed by another physician (for example, following treatment in the emergency department)?

A: There is no specific CPT code for this service. Use an office-visit code, such as 99211

Or)

http://www.physicianspractice.com/in...cleID/1201.htm

This is one of those "coding topics" that produces different opinions. For those carriers that recognize the code, HCPCS S0630 exists.
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Old 08-18-2009, 08:36 AM
dballard2004 dballard2004 is offline
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Why would you not append -55 to the E/M code in this case. I have never known it to be just for surgeries.
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Old 08-18-2009, 08:46 AM
RebeccaWoodward* RebeccaWoodward* is offline
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Dawson,

Debra may be referring to this (although, I don't want to put words in her mouth)

Modifier 55 Fact Sheet
Definition:


•Indicate a physician, other than the surgeon, is billing for part of the outpatient postoperative care.
•Also, used by the surgeon when providing only a portion of the post-discharge post-operative care.

Appropriate Usage:

•Billed for the surgeon and the physician, other than the surgeon, who furnished a portion of the outpatient postoperative care
Append to the procedure code that describes the surgical procedure performed that has a 10 or 90-day postoperative period.•The claim must show the date of surgery as the date of service.
•Indicate the date of care assumption and relinquished in Item 19 of the CMS-1500 claim form or the electronic equivalent.
•After the physician has seen that patient, submit a bill for the period beginning with the date on which they assumed care.
•When two different physicians share in the postoperative care, each bills for their portion-reporting modifier 55 and indicating the assumed and relinquished dates on the claim.

Inappropriate Usage:

•Appending to a surgical code without 10 or 90-day post-op period
•Appending to an E/M procedure code
•Appending to assistant at surgery services
•Appending to Ambulatory Surgical Center’s facility fees
•When the transfer of care occurs immediately after surgery with inpatient care provided, the receiving physician should bill subsequent hospital care codes. Payment will be allowed if they are not the same physician.*
•Do not report modifier 52 along with modifier 55 when furnishing only part of the postoperative care (MN providers only).

Facts
•The physician furnishing postoperative care must keep a copy of the written transfer agreement in the beneficiary’s medical record.
•Medicare payment is limited to the same total amount as would have been paid if one physician provided all of the care, regardless of the number of physicians providing care.

http://www.wpsmedicare.com/part_b/ed...odifier_55.pdf
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Old 08-18-2009, 08:58 AM
dballard2004 dballard2004 is offline
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This doesn't make sense. If the patient comes in to have the sutures removed and we did not put them in, we code the appropriate E/M code. How do we indicate that we are doing the postoperative part of this if we don't use -55?
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Old 08-18-2009, 09:41 AM
dballard2004 dballard2004 is offline
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Would the claim not be denied as the global period if we removed the sutures not placed by us during the global period?
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