Q&A: Filing a claim for suture removal

We almost always receive rejections from insurers when charging for suture removal in our office after our surgeons perform outpatient surgery in the hospital ER or outpatient center. How can we report these services to ensure they are paid?

Since there is no CPT code indicating suture removal per se, most practices simply use a low-level E/M service for that purpose (i.e., 99212). The only time it is appropriate to bill for suture removal, however, is when you are removing sutures placed by another Tax ID provider. The reimbursement for surgical services includes the removal of sutures placed during surgical procedures. It isn't appropriate to bill for suture removal if a surgeon from your group performed the original surgery. However, if the sutures were placed by an emergency room physician, it would be appropriate to charge for suture removal if the patient came to your office for the procedure.