EM Coding Alert

Question: Our pediatric practice is a part of a health system run by a local hospital. One of our patients was seen seven days ago at the emergency department (ED) of the hospital and received sutures for a chin laceration. Today, the patient visited our office to have the sutures removed. As our pediatrician did not place the suture, should we bill for the removal?

AAPC Forum Participant

Answer: Usually, suture removal is regarded as being a part of the postoperative package for the laceration repair. If the ED performed a simple laceration repair, billed with 12001-12018 (Simple repair of superficial wounds …), that is not an issue, as these services do not have a global period. In this case, your office can simply bill for the removal using a low-level office/ outpatient evaluation and management (E/M) service, usually 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 …) if performed by a nurse or 99212 (Office or other outpatient visit for the evaluation and management of an established patient …) when a physician performs an uncomplicated removal.

Things get a little trickier in this scenario if the ED performed an intermediate or complex laceration repair billed with 12031-12057 (Repair, intermediate …) or 13100-+13153 (Repair, complex …), which are assigned 10 days for postoperative care. Technically, as your patient presented to your office during that period, the removal would be regarded as part of the global package for the repair service.

As your office and the ED are different specialties, even though they are owned by the same health system, your pediatrician is not subject to the global period for the laceration repairs the ED performed. But that still doesn’t mean you should charge for the removal for the sutures. As your pediatrician and the ED are working under the same healthcare system, and the ED has already billed a global fee, technically your practice has already been paid for the postoperative care.

Under these circumstances, it may be best to waive any fees to the patient that you incurred for the removal. Alternatively, you could recoup a portion of the global procedure by appending modifier 55 (Postoperative management only). As this could result in the ED losing their portion of the postoperative care fee, you will have to negotiate with them to see if they are willing to bill this way. If they are, then they can use modifiers 56 (Preoperative management only) and 54 (Surgical care only) on the repair to indicate they are performing all parts of the repair service other than the postoperative care.