Question suture removal and billing an E/M

ltl226

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The scenerio is, the patient comes in for a suture removal. The provider evaluates the scar after he removes the sutures. He is using 99024 for the suture removal and an E/M for evaluating the scar. No future follow up regarding the scar has been recommended. Has anyone run into this? I have not seen other providers doing this. Are there guidelines regarding this.

Thank you in advance
 

csperoni

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This seems highly suspicious. Overarching criteria for any E/M is medical necessity.
Question 1 is Why is the provider evaluating the scar?
Question 2 is How is the provider evaluating the scar?
Question 3 is Wouldn't this be included in the global (assuming provider did the suture/procedure)?
 

ltl226

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Thank you for your response and I completely agree with your questions. These are the same questions I asked him. This is in the global period and I have explained that to him. He has since stopped doing this and is only coding 99024 now. I am just wondering if anyone else has seen this before and how did you handle it?
 

csperoni

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I'm fortunate enough to be in a position where the clinicians defer to my judgement for anything coding related. I make any changes required without clinician involvement. If I notice a specific clinician regularly making a repeated error, I will address. I consider part of my coding responsibility to educate clinicians about coding rules/regulations, making sure they realize I am not questioning or advising about clinical matters. Depending on the clinician/issue, I may send an e-mail, or speak with them directly assuring I am here to use as a resource if needed.
I also send educational group e-mails when needed. For example, with outpatient 2021 E/M changes, I sent a lengthy email describing all the changes along with a much shorter summary for the most common changes as they relate to the way our practice runs.
 

Orthocoderpgu

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It may not be this exact scenario but I think most if not all coders have run into scenarios where the clinicians can get creative to bump up their RVU's and income or to maximize what they are doing. I have been working with surgeons for about nine years and while they have tried to get "creative" at times, what they were doing seemed logical to them. None of them have ever tried to bill an E/M for the evaluation of a scar within the post op period. Christine is correct, there has to be medical necessity, and there is none. I'm glad the doctor backed down and is no longer pushing this issue, but if your doctor learns to trust your opinion, they will listen to you when communicate with them about coding issues.
 
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