Maiu Posted Mon 16th of January, 2012 20:07:36 PM
CPT code '12001' has a 0 day global period as per Medicare. In this case, would suture removal be billed as a separate visit or is it included? I would think that 0 day global would allow to bill separately for the follow up visit. Yet I have heard that suture removal is always included in the surgical procedure.
SuperCoder Answered Tue 17th of January, 2012 02:19:57 AM
Medicare changed the payment policy for simple laceration repairs in 2011 by changing the global surgical package from ten days to zero days. Basically this means that the follow-up visit for a wound check and suture removal is no longer included in the payment for suturing, stapling or using tissue adhesives on superficial wounds primarily involving the epidermis or dermis without deeper damage.
Rationale: The change came about in part because Medicare officials did not believe it was typical for emergency department patients to return to the ED where the sutures were placed to have them removed ten days later. Veteran coders will recall when simple laceration repairs were designated as starred procedures (*) in CPT®, meaning that the global surgical package concept did not apply to the indicated code. When that CPT® construct was removed in 2004, the simple repair codes took on a ten day global period, meaning all typical post operative follow up care was included in the payment and should not be reported separately if provided by the same physician.
There was confusion last year over how to report the follow-up visit when patients do return to the ED for suture removal and it is outside of the defined global surgical period. Medicare advised using an ED E/M code. This reporting strategy is consistent with the clinical example in Appendix C of the CPT® manual describing a visit for a patient to have “sutures removed from a well healed uncomplicated laceration.”
Keep in mind that private payers often follow Medicare global periods and payment policies, so you could use the same approach; but verify that each payer’s global period and resulting payment has actually changed before you start reporting the follow up visit for those patients. This fairly new practice may cause confusion for ED patients who are used to having their sutures removed for free; patients may be even more upset if they are faced with an additional ED visit co-pay, often over $100, for the follow-up visit.
I hope this helps.
Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions
Home office: (866) 458-2973