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General Surgery Coding Alert

5 Q&A's Bolster Your Suture-Removal Savvy

HCPCS code may be just the thing for private payers If you-re not reporting your physician's suture removals in certain tricky cases, you-re probably denying your surgeon legitimate reimbursement. Polish your suture coding skills by studying these frequently asked questions: E/M Alone Usually Describes Removal Question 1: Established patients frequently present to the office for removal of sutures that an emergency department (ED) physician placed. How should we code this? Answer 1: Unfortunately, CPT doesn't offer a specific suture-removal code that applies to physician offices. In fact, both CPT and Medicare consider suture removal a part of a minor surgical procedure's global package. When a physician removes sutures while the patient is under anesthesia, you could report either 15850 (Removal of sutures under anesthesia [other than local], same surgeon) or 15851 (Removal of sutures under anesthesia [other than local], other surgeon). But surgeons rarely use anesthesia to remove sutures, and your documentation must provide medical necessity to do so. Best bet: You should report a low-level E/M (for example, 99212, Office or other outpatient visit for the evaluation and management of an established patient ...) because this would be a "problem-focused" visit, says Lisa Barnes, CPC, a coder with Fayetteville Diagnostic Clinic, an Arkansas multispecialty practice. If your surgeon wants to bill suture removal at a higher E/M service level, be sure to double-check the documentation for medical necessity and evidence of greater physician effort or medical decision-making. Consider Modifiers 54 and 55 Question 2: Should we attach any modifiers to the E/M code? Answer 2: No, says Kathy Pride, CPC, CCS-P, director of government program services with QuadraMed in Reston, Va. "If you are going to use the modifier for postoperative management of a procedure, the CPT guidelines state that you should use the same code as for the physician performing the procedure, and you should append modifier 55 (Postoperative management only)," Pride says. "The physician performing the procedure should append modifier 54 (Surgical care only) to the procedure code." Example: An ED physician repairs a patient's minor laceration and bills 12001-54 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less), which has a 10-day global package. Attaching modifier 54 informs the carrier that the ED physician performed only the repair. When your surgeon performs suture removal, you-d report 12001-55. "Generally, the performing physician who appends modifier 54 receives 80 percent of the reimbursement, and the physician providing the postoperative care and appending modifier 55 receives 10 percent of the reimbursement," Pride says. (The remaining 10 percent is for preoperative care, reported with modifier 56, Preoperative management only.) Pitfall: Most physicians who perform laceration repair do [...]