Staple removal - HCPC code

[nancy.anselmo@ccrheart.com]

Is there a HCPC code to bill Medicare for staple removal? Dr removes the staples put in by another Dr not in our office. We use S0630 and are having a hard time getting insurances to pay and now Medicare says that is not a valid code to use when billing them. Thanks Nancy

 

[dede470]

Suture removal

Hi Nancy,
What I found out, is that S0630 is not payable by medicare, no matter what...so if your billing medicare don't use that HCPCS code. Some coders state, that if the doctor who put the sutures in did not put a modifier 54 (Surgical only) on his billing, then your doctor CAN NOT use modifier 55. Some state to use a low level E&M. But most agreed DO NOT use CPT code 15851 and put a 52 modifer on it.
Hope this info helps.

 

[mitchellde]

the only way to bill this is by using the same procedure code used by the surgeon and append a 55 modifier. IF the original surgeon did not use a 54 then you will have to work this on the back end. You must also include a transfer of care notation in field 19 to indicate that the surgeon transferred care to you for this reason. Your dx code will be V58.32.
If the surgeon did not transfer care to you for this post op, if the patient self referred to you for post op you need to try to get the patient back to the surgeon or bill the patient.