Wiki Wound Care - the proper code

[TMB1965]

For sutures being removed from a chin laceration, and the wound care is cpt code 97602 the proper code? This code was denied, because the 879.8 doesn't support medical necessity for this code. I'm thinking it should be 12002, so any help would be greatly appreciated.

This is what was billed out, and the size of the laceration was 3cm
99212-25
97602
90656
90460

 

[mitchellde]

There is no code for suture removal. Most minor lac repair codes have 0 global so you would've use a low visit level if supported by documentation. If the is a global, and your provider did not perform the repair, then you us the surgical code for the repair performed and append modifier 55. Also if this is suture removal you do not use the injury code you use the V58.32. For ICD-9 coding you do not code the injury after the initial repair, you must use V codes for aftercare. This will be much different for ICD-10CM where you code the injury with the 7th character to indicate subsequent or sequela, and do not use aftercare Z codes.

 

[TMB1965]

So if all the physician did was suture removal it needs to be a higher level E&M with the v58.32, and the 97602 wouldn't be billed?

 

[mitchellde]

If all the provider performed was suture removal it will be a low level E&M, it the documentation can support one. There will be no 97602 if suture removal is all that is performed. If the documentation does not contain elements to support a 99212, then you will use the 99211.

 

[m.edwards]

Suture removals within a global are not billable with any code (remember that intermediate and complex repairs have 10-day globals). If there is no global period such as with a simple laceration repair, then the suture removal is coded as an E/M service at the appropriate level based on the documentation.

Generally speaking, this would be a lower level E/M since it usually includes a problem focused history and exam and the medical decision making is relatively low/straightforward as well. If the service is performed by a nurse, you may only be able to bill a 99211.

The only time you would bill for a suture removal using a code other than an E/M code, would be if the sutures were placed elsewhere/by another physician. This would be coded as S0630 (Removal of sutures; by a physician other than the physician who originally closed the wound), but is a non-covered service with Medicare. We sometimes bill this code if sutures are placed in the ED and a patient is told to follow up with their primary care physician or with one of our surgeons.

97602 is usually used for wound care related to non-healing or slow-healing wounds such as chronic ulcers or non-healing surgical wounds.

Hope this helps!