Ophthalmology and Optometry Coding Alert

Suture removal after a procedure is one of the most frustrating areas of surgery for both surgeons and their coders. It is difficult for surgeons, because they want to be paid for doing work, and for coders because they know its not always reimbursed. Most physicians are aware of the rule that suture removal is part of the procedure its included in the fee they get for performing the initial operation. But what if they didnt expect to have to remove the sutures?

If a cataract patient returns because the sutures didnt dissolve and are now causing irritation, how can you bill for the removal of the sutures?

First, some general background about the global surgical package concept will help explain the situation. The global surgical package includes:

1. Preoperative visits Preoperative visits beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures.

2. Intraoperative Services Intraoperative services that are normally a usual and necessary part of a surgical procedure.

3. Complications Following Surgery All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room.

4. Postoperative Visits Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery.

5. Post-surgical Pain Management By the surgeon.

6. Supplies

7. Miscellaneous Services Items such as dressing changes; local incisional care; removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes.

As listed in miscellaneous services, suture removal is included in the global surgical package and cannot be billed separately, explains Lise Roberts, vice president of Health Care Compliance Strategies, a Jericho, N.Y.-based compliance, coding, and reimbursement consulting firm.

If, in a slightly different situation, the operative wound site needed to be revised, and the patient had to be returned to the operating room setting, the service could be billed in addition to the original surgery, she says. Just remember that Medicare does not consider the minor room or patient lane to be an operating room setting. To bill a wound revision that does take place in an operating room setting, use CPT code 66250 (revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) with the modifier -78 (return to the operating room for a related procedure during the postoperative period) appended.

Note: Medicare does consider a dedicated laser suite, or the room where a portable laser is at the time to be [...]