Pediatric Coding Alert

Question: One of our minor patients went to the emergency department (ED) for a laceration to his head that occurred on a weekend. He had sutures put in and was told to follow up with us in 7-10 days. At the office visit, the provider removed the sutures, cleaned and rebandaged the area, and spoke with the parent about wound care. I filed to insurance as 99213 with modifier 55, which the insurer paid at $15. Was the modifier incorrect? Pediatric Coding Listserv Subscriber Answer: You used the correct modifier but the wrong CPT code. You should have instead used modifier 55 (Postoperative management only) on the same laceration repair code (12001-13152) that the ED used. Modifier 55 designates the physician provided the postoperative care of the reported procedure code. For instance, if the wound was 3 cm, you would have assigned 12002-55 (Simple repair of superficial wounds of scalp, [...]