Use of S0630

[smaxwell4]

The physician I bill for is using HCPCS code S0630 according to the HCPCS Medicare doesn't allow this code. He believes they do. When I did bill for it the EOBs that I got back stated that this procedure code and modifier were invalid on the date of service. Is this a billable code if sure am I missing something

Any information would be great

Sarah

 

[dmaec]

this code is not payable by Medicare.
If your provider didn't place the sutures, (another provider NOT in his group did) and your provider is removing them - he should be coding an E/M (probably a low level) with the V-code suture removal. AND documentation so support his services of course!

If he did place them, and it's within the global and now he's removing them, he can't bill for that - period,...it's a global no charge.

it's payment status indicator is "E" - that means - Items, codes and services:
1)that are not covered by Medicare based on Statutory Exclusion
2)that are no covered by Medicare for reasons other than Statutory Esclusion
3)that are not recognized by Medicare but for which an alternate code for the same item or service may be available
4)for which separate payment is not provided by Medicare
EXPLANATION: "not paid under OPPS"

 

[Kiana]

I vote No as well, but if your physician wants to see it from Medicare, bill it then show him your denials. Physicians should be physicians, coders be coders.

 

[smaxwell4]

Thank you

Sarah CPC

 

[smaxwell4]

this code is not payable by Medicare.
If your provider didn't place the sutures, (another provider NOT in his group did) and your provider is removing them - he should be coding an E/M (probably a low level) with the V-code suture removal. AND documentation so support his services of course!

If he did place them, and it's within the global and now he's removing them, he can't bill for that - period,...it's a global no charge.

it's payment status indicator is "E" - that means - Items, codes and services:
1)that are not covered by Medicare based on Statutory Exclusion
2)that are no covered by Medicare for reasons other than Statutory Esclusion
3)that are not recognized by Medicare but for which an alternate code for the same item or service may be available
4)for which separate payment is not provided by Medicare
EXPLANATION: "not paid under OPPS"

My provider email me. He is not affiliated with any other the provider who put the sutures or staples in. This is wrote he wrote

However, sutures or staples removed by a different provider is billable for service.
I care for a lot of postoperative patients, especially at VISTA where
pt's often come from entirely different hospitals where they had their
surgery.

So since he is not affiliated with the providers can he then bill for this code.

Thank you

Sarah

 

[bsesender]

sutures

My provider email me. He is not affiliated with any other the provider who put the sutures or staples in. This is wrote he wrote

However, sutures or staples removed by a different provider is billable for service.
I care for a lot of postoperative patients, especially at VISTA where
pt's often come from entirely different hospitals where they had their
surgery.

So since he is not affiliated with the providers can he then bill for this code.

Thank you

Sarah

What we can bill and what will be paid are often two different things. In my experience the s code is not recognized by Medicare, although it is recognized by many commercial insurances. If removal of sutures by a physician other than those who placed the sutures is performed for a medicare patient an e&m service should be billed. Low level 99211 if this is the only thing performed, otherwise if physician has evaluated and documented the appropriate e&m level should be reported- but the suture removal is included with that service.

Bridget Brown, CPC

 

[luker]

HCPCS 2015 pg 125 States S codes are not payable by Medicare. It can be billed to commercial.

 

[SudhirK]

Hi Guys , i would suggest to bill the S code only for commercial , and yes provider should get paid for their efforts for medicare payer as well so if on same claim any enm was billed then suture removal will be inclusive in that if no any enm was billed on same claim then u can bill 99211 ..I hope it will help to understand .