Suture removal

MnTwins29

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This question has been posed to me from a compliance perspective for suture removal. A patient presents to the ER and has sutures inserted as part of a procedure. A proposal has been made to suggest to the patient to go to his primary MD for suture removal. If that can't be done, then the patient would present to the ER for removal. There are issues with this for ER co-pays - many of which are very high for a simple suture removal. Is this a problem if no bill is generated in the ER?
 

mitchellde

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As far as the facility charge? I would suggest that on your assesment tool for facility charges then you assign 0 points to a suture removal or something like that so that you can show why the visit was not charged out. In the facility I helped with this we used a point system that started with 5 points for a lowest visit level therefore anything that was less than 5 points was not billed out due to criteia not met for a level. Without knowing how you assign visit levels for the facility it is hard to advise. As far as the physician charge, it is global and not billable. Also for your physician charge if you send the patient to the PCP for removal then you must append the 54 modifier to the CPT code for the repair.
 

MnTwins29

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East Greenbush, NY
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Thanks!

Yes, this is for the facility charge, and I do know that they assign points. I don't have the breakdown in front of me right now, so I don't know the current point assignment for suture removal. But it is a suggestion I will present, if this is the way they wish to proceed.

Thank you.
 
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