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Primary Care Coding Alert

Reader Question:

Forget Modifier 55 for Suture Removal

Published on Tue Mar 06, 2012

Question: An established patient went to the emergency room in another state over the weekend because of a laceration to his foot. The ER staff sutured the cut and told him to follow up with our physician. At the office visit, the provider removed the stitches, cleaned and rebandaged the area, and spoke with the parent about wound care. We reported an E/M code with modifier 55, but insurance only paid $15. What did we do wrong?New Mexico SubscriberAnswer: The problem could lie in your use of modifier 55 (Postoperative management only) with an E/M code. You should use modifier 55 when another physician performs surgery and the family physician provides postoperative management/care. According to the description in Appendix A of CPT®, modifier 55 is added to the usual procedure number (i.e. the code for the surgical procedure). Payers then typically reimburse a percentage of their usual fee for the [...]
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