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Suture Removal

  1. #11
    Location
    North Carolina
    Posts
    3,126
    Default
    Medical Coding Books
    Maybe this will clarify.....

    Excerpt from 1-09 Coding Answer Book

    Suture removal is considered part of the global surgical package and therefore cannot be billed separately by the surgeon.

    When the surgeon transfers care of the patient to the attending physician or other physician/non-physician practitioner, suture removal is part of post-op care (-55). No separate charge is made. The performing physician bills Medicare for the entire post-operative care using the surgery date-of-service and the surgery procedure code with modifier -55. The surgeon in this case should submit the service using the surgery procedure code along with the -54 modifier.

    When the surgeon has not transferred care of the patient to the patient's attending physician/non-physician practitioner, the suture removal can be included in an evaluation and management service. If this is the only service provided to the patient, then procedure code 99211 can be used; this is the minimal level office visit procedure code. If the patient receives other E/M services at the same time, the suture removal would be included in the evaluation and management service

  2. #12
    Default
    Global rejections should only affect the provider that did the procedure. All other specialties/groups should be able to bill what they did with out worry of the global period since they did not take over the post-op care.

    I say should because there is always the possibility someone will reject in error and you have to fight it out.

    Laura, CPC, CEMC

  3. #13
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Now this makes sense. I always thought that 55 would apply to the E/M code in these types of situations. I thank both you for your guidance.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #14
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by rebeccawoodward View Post
    Maybe this will clarify.....

    Excerpt from 1-09 Coding Answer Book

    Suture removal is considered part of the global surgical package and therefore cannot be billed separately by the surgeon.

    When the surgeon transfers care of the patient to the attending physician or other physician/non-physician practitioner, suture removal is part of post-op care (-55). No separate charge is made. The performing physician bills Medicare for the entire post-operative care using the surgery date-of-service and the surgery procedure code with modifier -55. The surgeon in this case should submit the service using the surgery procedure code along with the -54 modifier.

    When the surgeon has not transferred care of the patient to the patient's attending physician/non-physician practitioner, the suture removal can be included in an evaluation and management service. If this is the only service provided to the patient, then procedure code 99211 can be used; this is the minimal level office visit procedure code. If the patient receives other E/M services at the same time, the suture removal would be included in the evaluation and management service
    Thank You Rebecca! I got caught up teaching all day and am just now getting a break, even though that is not the same source I used it is the same essential information, it is a hard concept to outline and I thank you for providing that resource it words it beautifully.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default Modifier 52
    I have been told to use CPT 15851 (removal of sutures under anesthesia, other than local, other surgeon) with a modifier 52 (reduced services) whenever removing sutures that were put in by another doc. Does anyone else code it this way?

  6. #16
    Location
    Columbia, MO
    Posts
    12,531
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    Quote Originally Posted by apmc View Post
    I have been told to use CPT 15851 (removal of sutures under anesthesia, other than local, other surgeon) with a modifier 52 (reduced services) whenever removing sutures that were put in by another doc. Does anyone else code it this way?
    I really feel that this is not appropriate to code this way for a suture removal.

    Debra A. Mitchell, MSPH, CPC-H

  7. #17
    Location
    Milwaukee WI
    Posts
    4,466
    Default No anesthesia = E/M
    I agree with Debra.

    If there is no anesthesia given then you bundled the suture removal into your E/M service. Whether you placed the sutures and it's outside the global period, or someone else placed the sutures is immaterial. No anesthesia = E/M.

    F Tessa Bartels, CPC, CEMC

  8. Default
    Our office receives a newsletter, and in one of the recent newsletters, it was stated that if sutures are removed the office may bill an e/m with mod -25 and sut rem code 15851 with mod -52 to show reduced services since no anesthesia is being used. I will find the newsletter and post later

  9. #19
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Who put out this newsletter? I would be very wary of this.

    Debra A. Mitchell, MSPH, CPC-H

  10. #20
    Location
    North Carolina
    Posts
    3,126
    Default
    I agree Debra...

    Excerpt from the Coding Answer Book...

    The issue is further confused when coders turn to codes 15850 [removal of sutures under anesthesia (other than local), same surgeon] and 15851 [removal of sutures under anesthesia (other than local), other surgeon] to try to provide a separate code for the removal. Would it ever be appropriate to use 15851 with reduced services modifier -52 to code the removal of sutures placed by another physician, but without the use of anesthesia?

    "No," the AMA CPT specialist answers. You don't need to go to that extent, because correct coding dictates you use an E/M code.

    If the physician removing the sutures was not the physician who performed the repair, I would charge the appropriate E/M code. For those carriers that recognize S0630, that could also be an option.
    Last edited by RebeccaWoodward*; 09-28-2009 at 07:37 AM.

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