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View Poll Results: Can you bill Medicare for S0630

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  • Medicare Coding

    2 50.00%
  • General

    2 50.00%
  • Coding

    0 0%
Results 1 to 7 of 7

Thread: Use of S0630

  1. #1
    Join Date
    Apr 2007
    Location
    Loma Linda
    Posts
    17

    Red face Use of S0630

    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

  2. #2
    Join Date
    Apr 2007
    Location
    Duluth, Minnesota
    Posts
    1,135

    Default

    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"
    Last edited by dmaec; 10-21-2008 at 02:45 PM. Reason: status indicator
    Donna, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    Location
    Tucson
    Posts
    94

    Default

    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.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  4. #4
    Join Date
    Apr 2007
    Location
    Loma Linda
    Posts
    17

    Default

    Thank you

    Sarah CPC

  5. #5
    Join Date
    Apr 2007
    Location
    Loma Linda
    Posts
    17

    Question

    Quote Originally Posted by dmaec View Post
    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
    Sarah M., CPC

  6. #6

    Default sutures

    Quote Originally Posted by smaxwell4 View Post
    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

  7. #7

    Default Use of S0630

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

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