Pediatric Coding Alert

Question: An established patient presents to my pediatrician's office for removal of sutures that an emergency department physician put in. How should I charge for the service?

Colorado Subscriber

Answer: Because another physician in an unrelated facility placed the sutures, you should report the appropriate level of E/M service (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for the suture removal. To show the insurer that your pediatrician didn't place the sutures, indicate on the claim form the original suture's location and the performing physician's name.

When the pediatrician provides a quick wound check and removes the sutures, you should report 99212. If she encounters any infection or problems with the sutures, the visit may warrant CPT 99213 if she documents the service's requirements. You should link 9921x to V58.3 (Attention to surgical dressings and sutures).

If an insurer rejects the E/M code, you may instead report HCPCS level II code S0630 (Removal of sutures by a physician other than the physician who originally closed the wound). For instance, Colorado Medicaid allows S0630, effective January 2001.