E/M Services Q&A
Sometimes getting paid for additional work takes ingenuity.
Q: In our family practice, I occasionally see documentation stating that one of our physicians removed sutures that were placed by another provider outside the practice, such as an emergency department physician. Should we code separately for the suture removal?
A: Both CPT® and the Centers for Medicare & Medicaid Services consider suture removal to be part of a minor surgical procedure’s global package. If the same physician who placed the sutures removes them during the original procedure’s global period, you cannot report the removal separately. If a different physician removes the sutures (as in your case), the removal becomes part of any evaluation and management (E/M) service reported.
Exceptions to this rule:
- If the patient must be placed under general anesthesia to remove the sutures, you may report 15850 Removal of sutures under anesthesia (other than local), same surgeon or 15851 Removal of sutures under anesthesia (other than local), other surgeon. Circumstances under which general anesthesia would be medically necessary or appropriate for suture removal are rare, however.
- Some private payers might allow you to report S0630 Removal of sutures by a physician other than the physician who originally closed the wound, as long as the physician who removed the sutures isn’t the one who closed the wound. Check with the payer before submitting this code.
If suture removal is the primary reason for the patient encounter, claim V58.3 Encounter for other and unspecified procedures and aftercare; attention to surgical dressings and sutures as the primary diagnosis.
Q: Can our physicians code separately for reading X-rays and other images taken somewhere else? For instance, may we report the appropriate X-ray CPT® code with modifier 26 Professional component attached?
A: If another provider (e.g., hospital radiologist) previously read/interpreted the image, and has submitted a claim, your physician cannot separately code or be paid for the same work (credit clay). For example, if the patient brings an X-ray report with him to his appointment, the provider does not earn payment simply for examining the films to determine the nature of the problem.
If the X-ray is relevant to the patient’s complaint, and the provider documents the relevance of this “data to be reviewed,” however, the effort of reviewing the images counts toward the complexity of medical decision-making when determining the appropriate E/M service level.
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.