Tammy Posted Tue 08th of April, 2014 07:04:03 AM
I have a patient of Dr. A that he did a procedure on and now needs a suture removal. The suture removal charge is globally included in the procedure charge, however Dr. A isn’t here to remove the sutures. Dr. B would most likely charge the patient because he didn’t administer the sutures/procedure, however, I’m not sure he can do that because the procedure charge was billed from our office. (Usually our physicians charge for the removal if they didn’t put the sutures in.) Dr. A and B practice from same office. Please let me know thanks!
SuperCoder Answered Tue 08th of April, 2014 16:43:31 PM
Although the CPT® code 15851 (Removal of sutures under anesthesia [other than local], other surgeon) seems to be an ideal choice for the case scenario that you have described, you cannot report 15851 if your internist performed the removal of sutures without the use of anesthesia. The codes 15850 (Removal of sutures under anesthesia [other than local], same surgeon) and 15851 should be used for suture removal procedures only when your clinician performs the removal of sutures with the use of general anesthesia.
You also cannot use the modifier 52 (Reduced services) to 15851 to indicate to the payer that there was a reduced service as anesthesia was not used during the procedure.
So, if this is the case scenario , it is best to report the services of your clinician by using a low level E/M code. If the patient has been previously under your physician’s care for other issues and is an established patient, you can report the service performed using an established patient E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient…).
If the patient is covered under a service other than Medicare, you can also consider using S0630 (Removal of sutures; by a physician other than the physician who originally closed the wound) to let the payer know that your physician is performing suture removal that was placed by another physician. But, before you report this code, it is best to check the payer’s guidelines to see if S0630 is a covered service or else your claim might get denied. In case, the payer is not covering the code, you can just resort to using the low level E/M code.