ED Coding and Reimbursement Alert

Not all suture removals are the same - so take this quiz and find out if you know how and when to code three variations of this suture scenario.
 
1. A physician in your practice previously saw the patient for the wound closure. The patient is a Medicare beneficiary, and the removal occurred during the global surgical period (for example, 12044, Layer closure of wounds, has a 10-day global period).
 
Answer: You could code the visit with 99024 (Postoperative follow-up visit, included in global service), says Susan Reese, CPC, CCP, director of coding and compliance for Medaphase in San Antonio. Many groups elect not to submit a code at all for this scenario, however, as there is an inherent fixed cost associated with coding the chart and billing the carrier.
 
Remember that Medicare has assigned zero relative value units for code 99024, so there is no associated payment. Of course, if the physician sees the patient for a second, documented reason, an ED code may be assigned, appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

2. You encounter the same circumstances as question 1, but your patient is covered by a private payer.
 
Answer: If the original service is a non-starred procedure (e.g., 12044), suture removal is bundled into the initial code - and as with Medicare, it is unlikely that the private payer will reimburse for this service as billed.

 3. You see the same situation, but this time the original service reported was a starred procedure (e.g., 12031*, Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less).
 
Answer: If the service is represented by a starred code, your carrier pays for only the initial surgical procedure. Therefore, you can report the suture removal in addition to an ED visit code (e.g., 99282, Emergency department visit for the evaluation and management of a patient ...) if the physician performs and documents the key components, Reese says. But make sure you know who did what: If another staff member removed the stitches without physician involvement, the insurer will only reimburse the facility - and you can't file a claim for the professional component of the service.
 
Due to the difficulty in tracking these patients (and often in the interest of good public relations), many groups ultimately elect not to bill for suture removals.
 
Note: When a physician not affiliated with your practice performs the repair, the ED physician will most likely perform a low-level E/M service (e.g., 99281 or 99282) to evaluate the wound, so you should probably report the E/M code.