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?