Pediatric Coding Alert
Getting Paid for Suture Removal
Several coding experts expressed concern about this to us, saying that suture removal is supposed to be included in the fee for putting in the sutures. Its part of the global, says Garnet Dunston, CPC, MPC, corporate coding specialist for Managed Care Solutions of Phoenix, AZ. Youre being paid for removing them when you do the surgery. Dunstons bottom-line message to Jackson: If she gets audited, shes going to have refund the money.
However, there are two points to remember here, advises Thomas Kent, CMM, office manager for Esther Y. Johnson, MD, FAAP, of Dunkirk, MD. First, for the most part, pediatricians are not covered by Medicare regulations, and, second, the laceration repairs they do are mostly starred procedures.
Suture removal is bundled into laceration repair by the Health Care Financing Administration for Medicare purposes only, adds Kent. This is because laceration repair is considered a surgical service, and therefore normal post-surgical care is bundled into that service.
The majority of laceration repairs performed by pediatricians are simple repairs using starred procedures, he adds. When a procedure is starred, that means that the service as listed includes the surgical procedure only, CPT states. Associated pre- and postoperative services are not included in the service as listed. And later on, it states: All postoperative care is added on a service-by-service basis.
So, Jackson has a good case for charging for suture removalespecially if the repair was one of the starred procedures (12001, 12002, 12004, 12011, 12013, 12031, 12032, 12041, 12051).
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Getting Paid for Suture Removal
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