Don’t Bill This Suture Removal Scenario as Incident-To
Question: A nurse practitioner (NP) at my practice removed sutures from a patient who received the sutures at a different facility. Can I bill this as a 99211? AAPC Forum Participant Answer: If the patient hasn’t been seen in your practice before this encounter, then the patient shouldn’t be considered an established patient, and the encounter cannot be billed as incident-to. An incident-to service can be billed when an auxiliary or nonphysician practitioner (NPP) team member provides services under a plan of care that has been established by their supervising physician. In this case, the treating provider would be the clinician who ordered the sutures as treatment. Any incident-to services could only come from within that initial provider’s immediate organization; therefore, incident-to evaluation and management (E/M) code 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional) wouldn’t be appropriate here. Instead, an E/M code like 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.) could be appropriate, along with add-on CPT® code +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code)). Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
