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Charge for E/M during 90 day?- per Coding Alert

  1. Default Charge for E/M during 90 day?- per Coding Alert
    Medical Coding Books
    Good Morning,
    Can anyone give feed back regarding charging for a visit during the 90 day global (Surgery related) in the January 27 Orthopedic coding Alert?

    My physician just handed me a sample copy, it reads as follows:

    Question- A patient went out of state for surgery ( a 90 day global PX) and came back to our practice for the suture removal. What can we charge? Can we charge the E/M visit using modifier 24 since we are taking over the patient's care?

    Answer- Code the suture removal as part of an office visit code (99201-99215, office or other outpatient visit) including v58.32 ( Encounter for removal of sutures). You do not need to append any modifiers. "Removal of sutures by other than the operating surgeon may be coded as a level of E/M service if the suture removal is the only p/o service performed, according to AMA's CPT Assistant (Spring 1992).

    Alternative: HCPCS does offer a suture removal code, S0630 (Removal of sutures by a physician other than the physician who originally closed the wound). But you should check with payers before using this code, which contains no RVU and is not recognnized by Medicare and several other carriers.

  2. #2
    I would say you can charge an office visit with -55.

  3. #3
    Duluth, Minnesota
    I agree with what your provider gave you. We've always coded out suture removal in that type of scenario. (if they were placed by outside physician - not from our facility). Typically they are very low level E/M's...usually not a New Patient because they tend to go their "regular" provider for the removal.
    no modifier is needed,...not 24 and not 55. It shouldn't get caught up at all.
    should be fine.

    and I'd use the Vcode - not the Scode
    Donna, CPC, CPC-H

  4. #4
    Milwaukee WI
    Default E/M or Procedure with -55 mod
    If you taking over ALL the postoperative care then the surgeon should have coded the procedure with a -54 modifier, and you would code the procedure with a -55 modifier (and take over the 90-day global period)

    If you are only removing the sutures, you would code the appropriate E/M level based on documentation (probably established patient 99212 or 99213).
    No modifier needed as you are not the surgeon who performed the procedure, so you are not covered by the global period.

    F Tessa Bartels, CPC, CEMC

  5. Default
    I agree with Tessa. If you'll be providng ALL of the post-op care, you should be charging the same surgical code used as the surgeon with modifier 55 (aftercare only).


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