Urology Coding Alert

Question: I have a case where the patient went out of state for surgery (a 90-day global procedure) and came back to our practice for the suture removal. What can we charge? Can we charge the E/M visit using modifier 24 since we are taking over the patient's care?Virginia SubscriberAnswer: When another independent surgeon, who is not an associate or partner of your urologist, performed the surgery, you should bill an E/M service for the suture removal. You do not need a modifier since your urologist, as a separate physician and not an associate or partner of the other surgeon, is not involved in the other physician's global period.Code the suture removal as part of an office visit (99201-99215, Office or other outpatient visit ...) including ICD-9 code V58.32 (Encounter for removal of sutures). You do not need to append any modifiers. "Removal of sutures by other than the operating surgeon may be coded as a level of E/M service if the suture removal is the only postoperative service performed," according to the Spring 1992 CPT Assistant.Alternative: HCPCS does offer a suture removal code, S0630 (Removal of sutures by a physician other than the physician who originally closed the wound). But you should check with payers before using this code, which contains no relative value units and is not recognized by Medicare and several other carriers.Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.