Coding Cues

January 19, 2007

Suture removal

Honor the global period

The laceration repair codes-12001-13153-have a 10-day global period, and the codes already include the suture removal. So if a patient returns to you for suture removal within those 10 days, you can't report the procedure separately because it's already part of the global service.

For example, you performed a laceration repair eight days ago on a patient for a 3 cm cut on her scalp, and she comes to you to remove the stitches. The original procedure code you reported-12002 (simple repair of superficial wounds of scalp. . . )-already includes the suture removal. So you can't bill for it.

You should still submit this nonbillable work with 99024 (postoperative follow-up visit, normally included in the surgical package . . .). The code will allow you to keep track of the visit for utilization purposes to show that the patient did present for a follow-up visit within the surgical period. Use it along with V58.32 (encounter for removal of sutures).

Use an appropriate E&M

What if you sutured the patient and then removed the sutures after the procedure's global period? In that case, you can incorporate the suture removal into an E&M visit. You'd code the same way if you aren't the doctor who originally sutured the patient.

"When we remove any sutures in the doctor's office or in our urgent care facility, we use the appropriate level of E&M based on the entire service provided to the patient at that visit," says medical biller Ronda Scalise of Premier Medical Group in Clarksburg, WV.

For instance, a 60-year-old patient gets a large cut on his hand while on an out-of-state vacation and visits the local emergency department for suturing. The emergency doctor reports 12044 (layer closure of wounds of neck, hands, feet . . .), but the patient returns home the next day, so the original physician can't perform the suture removal.

When he visits you, his personal physician, you would report a low-level E&M, such as 99211 or 99212. It's unlikely that you could use a higher-level E&M because the history, exam, and medical decision-making are minimal for suture removal. Don't forget to link the visit with V58.32.

Use modifiers –54 and –55?

When a different physician sutured the patient, you may be tempted to use modifier –55 (postoperative management only) when you remove the sutures. After all, modifier –55 is used to identify the postoperative management when a different physician performs the surgical procedure. So this may sound like the perfect answer to a situation in which an emergency physician applies the sutures and the patient's physician removes them. But using the modifier isn't correct in this situation.

For example, a patient was injured in a car crash, and the emergency physician does a complex laceration closure on the patient's face and arm. The physician reports 13132 (repair, complex, forehead, cheeks, chin. . .) for two wounds on the forehead and cheeks, and 13121 (repair, complex, scalp, arms, and/or legs. . . ) for arm lacerations. The doctor then tells the patient to follow up with her personal physician.