Ophthalmology and Optometry Coding Alert

Question: One of our physicians recently performed a suture removal following a trabeculectomy. She insists the procedure is billable because laser performed it, but I'm not convinced. Does a code for this really exist? Arkansas Subscriber Answer: Way to stick to your coding instincts on this one. There are no codes for a suture removal for eye procedures because it is not payable separately from the global surgical package, according to Medicare. Medicare has already included relative value units for suture removal in the fee for trabeculectomy, as well as most other operations, thereby including suture removal in the global surgical package. In contrast, if your physician removes sutures placed during a surgical procedure performed by another physician, there is opportunity for some reimbursement.

For example, a patient had a corneal transplant by a specialist located 75 miles away and visits his local ophthalmologist five weeks into the postoperative period complaining of a "scratchy" feeling in the operated eye. If the local ophthalmologist examines the patient and discovers a protruding suture that she subsequently removes, she can bill the service with an E/M code, 99201-99215. The specialist would not have been permitted to bill for the suture removal because suture removal is included in the global surgical package, even if a physician other than the surgeon removed the suture(s).

The fact that the local ophthalmologist did not perform the original surgical procedure entitled her to payment for her service, regardless of the global period. As for private payers, reimbursement could still be difficult. Be sure to carefully document the circumstances as well as the services rendered and consult the carrier before coding the claim.