# Billing e/m for suture removal after global



## JesseL

If an excision was done and the patient came back after the ten day global, is it okay to bill a 99212 for the provider removing the stitches and discussing path results?


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## mitchellde

The answer depends on why the patient returned after the global.  If it was due to a scheduling difficulty then no you cannot charge for suture removal.  If it was due to slow healing then yes you can.


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## teresabug

actually it depends on "where" the patient had sutures placed. Some areas of the body require that sutures stay in over 10 days. (I coded for a derm for 2 years.)
As far as the Dr. reviewing the path results with the pt and/or family, you can bill an E/M for this past the global period. Make sure the Dr.'s note for this date explains the counseling provided and the % of time her spent counseling. My mother had melanoma and her post op appts were never short and sweet. Let me know if you have any more questions.

Teresa


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## JesseL

Patient came back 3 weeks later after the surgery. Doesn't say why.

Would this be insufficient documentation?

*Encounter for removal of sutures*
Erythematous and well healed scar located on left chest
Medical Decision Making: Encounter for removal of sutures , observe
POC: Recommendation is pathology: steatocystoma. Explained that if scar becomes thickened, we may consider injection of medication in 1 month., sutures removed without complication. Wound healing well.  Pathology results discussed.


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## teresabug

my personal opinion after reviewing this note is that the provider is having the patient come back after the global period is up so that he can bill an e/m code. THere was no explanation as Deborah stated above as to why the pt was seen 3 weeks post op. Along with a hx, exam and MDM, there also has to be medical necessity for a pt to be seen. IMO this care should have been performed during the  p.o. period with a claim sent out with CPT 99024
This provider is at risk if he continues to do this.

Teresa


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## JesseL

Its usually the patient's preference not the providers to show up after the global.  For some reason they don't mind leaving sutures on themselves longer.  They're busy people I guess.

I usually never bill the E/M even if the patient shows up after the global unless it's skin cancer which isn't very often.

But yea I think I'll stick with not billing the E/M.

Another thing that stinks is the provider has lazy scribers that won't type anything for their life but tries to use templates all the time, leading to crappy documentation.


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## teresabug

or the patients that take their own sutures out... I'd be too scared to even attempt that...

yep, good ol' EHR cloning. Show him the OIG workplan. Might help encourage him to train scribes and double check their charting, which we all know he should be doing anyway.


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## mitchellde

There was an excellent article in the March 2015 Coding Edge regarding cloning.. It is an eye opener.  You should get a copy and leave on the providers desk.


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## JesseL

The problem is people don't want to learn and my boss doesn't want to fire anyone so not so much I can do but bill what I feel is right.  I just bill less if I get the sense that there's over documentation.  The law should make all the damn EMR'S/PMS's/EHR's disable cloning.


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## chalze

*Billing Suture Removals Outside The Global Persion*

If the patient returns after the global period for suture removal can I bill a 99211? I have providers that do not want to bill and others that do. We are attempting to decide what we should do. In these cases we put the sutures in and the providers wants the patient to come back in 12-14 days, the global period for the procedure is 10 days. Is there any documentation on this? Thanks,
Cannie


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## CodingKing

chalze said:


> If the patient returns after the global period for suture removal can I bill a 99211? I have providers that do not want to bill and others that do. We are attempting to decide what we should do. In these cases we put the sutures in and the providers wants the patient to come back in 12-14 days, the global period for the procedure is 10 days. Is there any documentation on this? Thanks,
> Cannie



You should not purposely schedule a patient out after the global period in order to bill. It's disrespectful to the patient as well to cause them a copay or deductible when they have already paid for the surgery and all it entails.


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## michedv50

*Billing for suture removal after a "0" day derm procedure...*

Hello, 

I am trying to find verbiage to back up an opinion. I have a coder who insists that removing sutures, 10 days after a skin biopsy where they were placed(11100-11101) can be billed separately with an E/M. She believes its because the biopsy itself has "0" global days. My understanding is that regardless of the number of global days, if the suture removal is done by the same provider that put them in, it cannot be billed.  Yes?  Help? I am ok with being wrong, educate me. This is what I have found so far from a 2013 article by the American Academy of Dermatology Assoc.

Spring 2013 DCC Clarification
Suture Removal Q&A
The spring 2013 Derm Coding Consult issue raised questions
on the appropriate reporting and billing for suture
removal. According to AMA CPT and the Centers for
Medicare and Medicaid, suture removal is included in the
surgical package. It doesn’t matter if the surgical procedure
has a 0, 10 or 90 global period, the suture removal in
included in the procedure. Only when sutures are placed
by another practice or facility or physician that has no association
(Tax ID) with your practice then it is appropriate
to report the suture removal. The question is how this is
reported since there really is no CPT code.
The Coding Q&A shared a HCPCS code, S0630, Removal
of suture: by a physician other than the physician who
originally closed the wound. Although this S code could
be reported, few carriers honor it especially Medicare.
According CPT® Assistant, “Removal of sutures by other
than the operating surgeon may be coded as a level of E/M
service if suture removal is the only postoperative service
performed.” When the sutures are placed by the same
physician removing them there is no appropriate CPT code
to report. 

Thank you!

Michele Davis, CPC, CPC-I, CRC


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