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Stitch Removal

  1. #1
    Default Stitch Removal
    Medical Coding Books
    How can we bill stitch removal when another location (ie ER or other physician) did the wound repair?

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    You can bill with an E/M code.

  3. #3
    Default
    It gets denied as being in post-op period. We even tried using the modifier 55 with E/M, but denied too. Now what?

  4. #4
    Location
    St. Louis, Missouri
    Posts
    262
    Default
    If your physician did not put the sutures in, then you should bill an E&M code with no modifier. If that is getting denied, you need to appeal it.

    Melissa Blow, CPC

  5. #5
    Default
    What level E/M are you billing? I would only bill a 99211 for suture removal with V58.32. If that is what you are billing and you are receiving a denial I would appeal. In your appeal letter I would state that your physician did not place the sutures and s/he should be compensated for their time and services. You can find information regarding this topic in Family Practice Management Journal July/August 1999 and March 2000. I wouldn't bill any higher level because the provider isn't performing an exam, history or doing MDM for a suture removal. If the provider is doing that and you are coding a higher level be sure it is clearly documented as well as the medical necessity.
    Christina Lee Wagner, CPC, CPC-H

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I think a 99212 would be medically necessary and easy to document. The provider has to get a history about the injury, examine the wound, and remove the sutures. Right there you have a problem focused history and exam and straightforward MDM.

  7. #7
    Default
    Thanks for everyone's input!

  8. #8
    Default
    Our providers usually bill a 99212. We do not use a modifier. Our providers always do an exam to make sure not infected, etc. We don't just have the nurse remove the stitches without a provider doing an E/M.

  9. #9
    Default
    It's odd that you are getting global denials. Are you sure it wasn't a doctor in your group that did the original procedure?

    Global denials would apply if you are billing for the physician or another physician in the same group practice who did the original procedure.


    Erica

  10. Default
    What about HCPCS code for suture removal? S0630 is removal of sutures by a physician other than the physician who originally closed the wound (not paid by medicare but many other carriers allow). I would bill E&M with this code and no modifiers. Does anybody else have suggestions on how to bill using the HCPCS code?

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