Pediatric Coding Alert

How to Get Suture Removal Pay Without Using A Procedure Code

- Published on Fri, May 21, 2004


Latest on CPT Code for Suture Removal from SuperCoder's Pediatric Coder

Mythbuster: Sort Out These Suture Removal Facts Against 3 Misconceptions

Formula: Removal with anesthesia = 15850 or CPT 15851

The bad news: suture removal is usually bundled into the global, so forget about earning that extra revenue by billing it separately. The good news: you can take advantage of basic coding options available that will improve documentation and save you out of compromising situations.

Learn the tricks of the trade by resolving these 3 myths.

Myth 1: 99024 Is a “Trophy” Code

Reality: You think that just because 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a... read the full article, CPT guidelines, fee schedules, LCD and CCI edits related to Suture Removal in one place, subscribe to SuperCoder's Pediatric Coder.

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sutures is supposed to see the patients postoperatively." But a physician will often perform only the placement.

Modifier -55 Unlocks Suture Removal Pay

Scenario: A mother brings her child to her pediatrician's office for suture removal. An emergency department (ED) physician had placed the sutures to close a toddler's intermediate 2.4-cm forehead gash (12051 Layer closure of wounds of face ears eyelids nose lips and/or mucous membranes; 2.5 cm or less) but the mother had not wanted to wait in the ED to have the child's sutures removed.

In this case the ED physician would ideally append modifier -54 (Surgical care only) to his suture placement code. A patient usually won't return to the ED for suture removal Lee says. "Appending modifier -54 to the laceration code (12051) would indicate that the physician is not overseeing the postoperative care."

If the ED physician uses modifier -54 the postoperative care could remain unclaimed. "The physician who removes the sutures could then receive partial payment for suture removal " Lee says. In this case you would append modifier -55 (Postoperative management only) to the  laceration code (12051) to indicate that you are billing the postoperative care only.

Reality: The original physician will most likely not append modifier -54 to the laceration code. "He will probably bill for the whole 10-day global package " Lee says. So if you report the suture removal with the laceration code (12051) the insurer will deny the procedure as duplicative.

E/M Is a Realistic Alternative

Tip: You can avoid double-dipping for the repair if you instead [...]

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