Wiki Suture Removal

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
E
Suture Removal

Charge a 99211 with a 55 modifier if the procedure had a 10 day global visit.

JCampbell

Guru
Messages
164
Best answers
0
Pt came in and the nurse removed the sutures. Sutures were put in by another office. Can our office bill a nurse visit for this since the dr did not remove the sutures?

Thanks
 

LLovett

Guest
Messages
1,722
Best answers
0
As long as the note supports it yes you can.

If all it says is "suture removal" then no, that is not billable as a 99211. Even though it is low level and doesn't technically have defined key components, 99211 is still and E/M service. So you would have to have a chief complaint and documentation that supports an evaluation and management service was provided.

Laura, CPC, CEMC
 

dballard2004

True Blue
Messages
1,168
Location
Gower, MO
Best answers
0
I agree, but I would also note to append modifier 55 to the E/M code to indicate post management if it is a procedure that has a 10 day global. If it has a 0 day global, don't use the 55.
 
Last edited:

mitchellde

True Blue
Messages
13,390
Location
Columbia, MO
Best answers
1
The 55 modifier is appended to surgical codes it is not an E&M modifier. Your nurse may NOT remove sutures put in by another physician, your nurse may only follow orders by her physician. Also the sutures are global to the physician that put them in. If the repair has a 10 day global, then the physician that put them in either takes them out or transfers the care to you. If a transfer has occurred, you must document this in the chart, and put a note in box 19 of the 1500 to indicate a transfer of care, your physician must evaluate the patient and then either remove the sutures or he may pass it off to your nurse. The CPT code will not be an E&M it will be the same laceration repair code used in the ER with a 55 modifier. It is not pretty but that is the way it is to be done.
 

LLovett

Guest
Messages
1,722
Best answers
0
Debra,

Can you please give your source for this information?

This is not how I have ever handled this situation in any of the 3 states I have worked in. I can honestly say I have never had a transfer of care on sutures before. We had an elderly man a couple of weeks ago that didn't even know he had stitches until the doctor was examining him and told him they need to come out.

Thanks

Laura, CPC, CEMC
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
Q&A from CPT Assistant, Dec. 2002, on suture removal:

"If a physician removes sutures during an office visit that were originally placed by a different physician, how should the suture removal be reported?

AMA Comment: There is not a separate code that describes removal of sutures when the removal is not performed under anesthesia. If the physician who removed the sutures did not place the sutures, then the suture removal would be considered part of evaluation and management (E/M). Removal of sutures by the physician who originally placed them is not separately reportable."

Or)

Suture removal (American Academy of Family Physicians)

Q: What code should I use for in-office removal of sutures placed by another physician (for example, following treatment in the emergency department)?

A: There is no specific CPT code for this service. Use an office-visit code, such as 99211

Or)

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1201.htm

This is one of those "coding topics" that produces different opinions. For those carriers that recognize the code, HCPCS S0630 exists.
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
Dawson,

Debra may be referring to this (although, I don't want to put words in her mouth)

Modifier 55 Fact Sheet
Definition:


•Indicate a physician, other than the surgeon, is billing for part of the outpatient postoperative care.
•Also, used by the surgeon when providing only a portion of the post-discharge post-operative care.

Appropriate Usage:

•Billed for the surgeon and the physician, other than the surgeon, who furnished a portion of the outpatient postoperative care
Append to the procedure code that describes the surgical procedure performed that has a 10 or 90-day postoperative period.•The claim must show the date of surgery as the date of service.
•Indicate the date of care assumption and relinquished in Item 19 of the CMS-1500 claim form or the electronic equivalent.
•After the physician has seen that patient, submit a bill for the period beginning with the date on which they assumed care.
•When two different physicians share in the postoperative care, each bills for their portion-reporting modifier 55 and indicating the assumed and relinquished dates on the claim.

Inappropriate Usage:

•Appending to a surgical code without 10 or 90-day post-op period
•Appending to an E/M procedure code
•Appending to assistant at surgery services
•Appending to Ambulatory Surgical Center’s facility fees
•When the transfer of care occurs immediately after surgery with inpatient care provided, the receiving physician should bill subsequent hospital care codes. Payment will be allowed if they are not the same physician.*
•Do not report modifier 52 along with modifier 55 when furnishing only part of the postoperative care (MN providers only).

Facts
•The physician furnishing postoperative care must keep a copy of the written transfer agreement in the beneficiary’s medical record.
•Medicare payment is limited to the same total amount as would have been paid if one physician provided all of the care, regardless of the number of physicians providing care.

http://www.wpsmedicare.com/part_b/education/modifier_55.pdf
 

dballard2004

True Blue
Messages
1,168
Location
Gower, MO
Best answers
0
This doesn't make sense. If the patient comes in to have the sutures removed and we did not put them in, we code the appropriate E/M code. How do we indicate that we are doing the postoperative part of this if we don't use -55?
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
Maybe this will clarify.....

Excerpt from 1-09 Coding Answer Book

Suture removal is considered part of the global surgical package and therefore cannot be billed separately by the surgeon.

When the surgeon transfers care of the patient to the attending physician or other physician/non-physician practitioner, suture removal is part of post-op care (-55). No separate charge is made. The performing physician bills Medicare for the entire post-operative care using the surgery date-of-service and the surgery procedure code with modifier -55. The surgeon in this case should submit the service using the surgery procedure code along with the -54 modifier.

When the surgeon has not transferred care of the patient to the patient's attending physician/non-physician practitioner, the suture removal can be included in an evaluation and management service. If this is the only service provided to the patient, then procedure code 99211 can be used; this is the minimal level office visit procedure code. If the patient receives other E/M services at the same time, the suture removal would be included in the evaluation and management service
 

LLovett

Guest
Messages
1,722
Best answers
0
Global rejections should only affect the provider that did the procedure. All other specialties/groups should be able to bill what they did with out worry of the global period since they did not take over the post-op care.

I say should because there is always the possibility someone will reject in error and you have to fight it out.

Laura, CPC, CEMC
 

dballard2004

True Blue
Messages
1,168
Location
Gower, MO
Best answers
0
Now this makes sense. I always thought that 55 would apply to the E/M code in these types of situations. I thank both you for your guidance.
 

mitchellde

True Blue
Messages
13,390
Location
Columbia, MO
Best answers
1
Maybe this will clarify.....

Excerpt from 1-09 Coding Answer Book

Suture removal is considered part of the global surgical package and therefore cannot be billed separately by the surgeon.

When the surgeon transfers care of the patient to the attending physician or other physician/non-physician practitioner, suture removal is part of post-op care (-55). No separate charge is made. The performing physician bills Medicare for the entire post-operative care using the surgery date-of-service and the surgery procedure code with modifier -55. The surgeon in this case should submit the service using the surgery procedure code along with the -54 modifier.

When the surgeon has not transferred care of the patient to the patient's attending physician/non-physician practitioner, the suture removal can be included in an evaluation and management service. If this is the only service provided to the patient, then procedure code 99211 can be used; this is the minimal level office visit procedure code. If the patient receives other E/M services at the same time, the suture removal would be included in the evaluation and management service
Thank You Rebecca! I got caught up teaching all day and am just now getting a break, even though that is not the same source I used it is the same essential information, it is a hard concept to outline and I thank you for providing that resource it words it beautifully.
 

apmc

Guest
Messages
38
Best answers
0
Modifier 52

I have been told to use CPT 15851 (removal of sutures under anesthesia, other than local, other surgeon) with a modifier 52 (reduced services) whenever removing sutures that were put in by another doc. Does anyone else code it this way?
 

mitchellde

True Blue
Messages
13,390
Location
Columbia, MO
Best answers
1
I have been told to use CPT 15851 (removal of sutures under anesthesia, other than local, other surgeon) with a modifier 52 (reduced services) whenever removing sutures that were put in by another doc. Does anyone else code it this way?
I really feel that this is not appropriate to code this way for a suture removal.
 
Messages
4,466
Location
Milwaukee WI
Best answers
0
No anesthesia = E/M

I agree with Debra.

If there is no anesthesia given then you bundled the suture removal into your E/M service. Whether you placed the sutures and it's outside the global period, or someone else placed the sutures is immaterial. No anesthesia = E/M.

F Tessa Bartels, CPC, CEMC
 
Messages
3
Best answers
0
Our office receives a newsletter, and in one of the recent newsletters, it was stated that if sutures are removed the office may bill an e/m with mod -25 and sut rem code 15851 with mod -52 to show reduced services since no anesthesia is being used. I will find the newsletter and post later
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
I agree Debra...

Excerpt from the Coding Answer Book...

The issue is further confused when coders turn to codes 15850 [removal of sutures under anesthesia (other than local), same surgeon] and 15851 [removal of sutures under anesthesia (other than local), other surgeon] to try to provide a separate code for the removal. Would it ever be appropriate to use 15851 with reduced services modifier -52 to code the removal of sutures placed by another physician, but without the use of anesthesia?

"No," the AMA CPT specialist answers. You don't need to go to that extent, because correct coding dictates you use an E/M code.

If the physician removing the sutures was not the physician who performed the repair, I would charge the appropriate E/M code. For those carriers that recognize S0630, that could also be an option.
 
Last edited:

mitchellde

True Blue
Messages
13,390
Location
Columbia, MO
Best answers
1
I have a couple of issues with these articles. First of all in the coding institute article, you do not youe the wound code to indicate the laceration site. That code indicates a new acute process which is an untrue statement. The coding guidelines and coding clinics state that after treatment we do not use the original wound/fx code, now it is either an aftercare code or there is a complication. So suture removal is the aftercare V code only.
The article Heather sited states that the 99211 is not for physicians at all. This is untrue as well, the 99211 is a physician level, it may be performed by a physician, it may also be used when ancillary personnel are the ones with the patient carrying out the plan of care dictated by the physician in a previous encounter, but while the physician is on site.
I just wanted to get that out in the open as I often read articles that have misleading if not untrue statements.
 
Messages
4,466
Location
Milwaukee WI
Best answers
0
Articles cited by Heather

Both the articles in the links provided by Heather tell us to code the appropriate level E/M code when removing sutures WITHOUT anesthesia.

F Tessa Bartels, CPC, CEMC
 

mitchellde

True Blue
Messages
13,390
Location
Columbia, MO
Best answers
1
I did see that as well although one of them did state to use the 55 modifier. The only problem I have with using a visit level is that if this visit is within the post operative globla then many payers will deny it even though it is a different physician. That is when you want to use the 55 modifier with the procedure code.
 
Top