# suture removal-I need help



## vj_tiwari

Hey,

I need help regarding, If patient come to ED for suture removal for knee lacer.(which placed in the same ED, 9-10 days ago) then my CPT code is 99024 or 99281? 

Actully I'm confused about suture removal has a postoperative period (surgical packege) or not. 

Thanks for you're valuable help! 

VJ.


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## PURNIMA

Hi VJ,

Laceration repairs come under 10 day global package.

For a laceration revisit within 10days without complication-  if the encounter is just for a recheck or a suture removal without any additional work up or complication, we need not bill the visit.

For a laceration revisit within 10days with complication - Within 10 days, patient comes in with any complication due to repair or in the site of laceration (or) any new complication other than laceration, we can code the record.

For  laceration repair after 10 days -irrespective of with or without complication we can code the encounter.

Hope this helps,

Thank You and Have a great day!

Purnima S, CPC


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## vj_tiwari

Hey,

Thanks Purnima...  

But for the codition without complication, we didn't even code V58.32, 99281 (or 99024)? Please specify.

Also provide the CPT codes for the coditions u metioned as with or w/o complication. And also please specify where to use 99024 (Are we use for suture removal/ wound check- surgical, non surgical ?) ?

Thanks for ur valuable help! 

VJ.


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## keke74

If the pt comes in w/out complications, suture removal/wound check only, you would use 99024 & v58.3XXX. If the pt comes in w/complications you can code the encounter using the ER E/M Codes. Hope this helps!!!


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## mitchellde

vj_tiwari said:


> Hey,
> 
> I need help regarding, If patient come to ED for suture removal for knee lacer.(which placed in the same ED, 9-10 days ago) then my CPT code is 99024 or 99281?
> 
> Actully I'm confused about suture removal has a postoperative period (surgical packege) or not.
> 
> Thanks for you're valuable help!
> 
> VJ.


It is really important to know if you are coding for the physician or the facility as the answer is just a little different.


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## vj_tiwari

mitchellde said:


> It is really important to know if you are coding for the physician or the facility as the answer is just a little different.



Hey,

Please let me know for the both .....!


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## PURNIMA

*Suture removal*

VJ,

Good Day!

Here you go with the response:

1. we didn't even code V58.32, 99281 (or 99024)?Please specify. - Normally for a recheck or a sure removal within 10day global days, we need not bill the account, stating the reason as "NC Global".
2.a) Also provide the CPT codes for the coditions u metioned as with or w/o complication - If the patient returns with complication within 10day period - code with appropriate E/M level as per the documentation and MDM.

2.b) Without complication - after 10days global period - ICD would be V58.32 and E/M level would be 99281 or 99282.

3. And also please specify where to use 99024 (Are we use for suture removal/ wound check- surgical, non surgical ?) ? - I work for a physician and normally we are not using this code, sorry I could not help you in this,and I dont want to mislead you.

Hope this helps you.

Please revert in case of any further questions

Thank You,

Purnima S, CPC



vj_tiwari said:


> Hey,
> 
> Thanks Purnima...
> 
> But for the codition without complication, we didn't even code V58.32, 99281 (or 99024)? Please specify.
> 
> Also provide the CPT codes for the coditions u metioned as with or w/o complication. And also please specify where to use 99024 (Are we use for suture removal/ wound check- surgical, non surgical ?) ?
> 
> Thanks for ur valuable help!
> 
> VJ.


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## vj_tiwari

Hi Purnima, 

Thank you very much. That's what I need, yaa still one question remaining (for facility). But nicely done... 

If you know Hindi, then this is for u...

KYA BAAT .

              KYA BAAT ..

                                KYA BAAT ...!

VJ.


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## cpccoder2008

mitchellde said:


> It is really important to know if you are coding for the physician or the facility as the answer is just a little different.


 
I would also like to know for both. Thanks


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## mitchellde

Sorry we had a major power outage here and everything just came back up!  The facility has no global period at all so if the patient returns to the ER for suture removal the facility can and should charge an ER level even though the ER physician cannot if it is in global.  The facility is required to construct a "tool" that tells how the facility levels are arrived at in their facility, it does not necessarily match the physician level for the same service.  So the facility will use the V58.32 dx code and then an ER level say a level 1 using either the 99281 or the G code for that same level depending on payer.


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## cpccoder2008

I just goggled this same question and find this on another forum. I'll post it all. 

ER coding question

  If a patient has a procedure done in the ER (such as I & D ) that has a 10 day global, if the patient returns within the 10 days do i bill 99281 or 99024 ? or is 99024 only for major surgery 


  It depends.  Why is the patient returning to the ER? 


 What type provider is doing the procedure?

_ If it is an ER Specialist, the Global concept does not apply. By the nature of their scope of practice an ER provider/specialist does not provide follow-up care. Follow-up care is part of the Global package and in order to bill "Global" you need to provide all the services included._

If the provider is not an ER provider, you may bill the Global code. 99024 would be appropriate for usual follow-up care. Exceptions would be if patient presents with a new, unrelated problem...then you could bill an established patient visit (E/M) with 24 modifier attached. If patient is a Medicare patient, you'll need to check your carrier's policy as Medicare has additional rules about what's included in a Global and what constitutes a "new problem" or complication  unrelated.

99024 is for related, usual, post-op visits within any Global period. This applies to the provider, or member of their same group and specialty, who provided the original service. 

  its an ER provider for a hospital, that patient is told to return within 10 days for packing removal and follow up, just like a laceration repair, the patient is told to return with 10 for suture removal, i know that if the provider did the procedure that the follow up is including if they return within the globel days, but because it is an ER setting i bill 99281 for suture removal or checking of an abscess 


  If the provider is the same one (or member of same specialty,same group) who placed the sutures, he/she may not bill separately for removing them. The fee paid for placing the sutures includes remvoval of them.


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## cpccoder2008

Is the statement true that an ER physician cannot provide follow up care ?


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## PURNIMA

VJ,

Here is the update from ACEP facility guideline on Suture removal - "Wound recheck, Simple suture removal, return note for work/school would be coded with level 1 - 99281"

Hope this helps you,

And thanks for that statement, however I have very minimal knowledge over Hindi (thoda thoda maalum hai)

Thank You and have a great day!

Purnima S, CPC


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## cpccoder2008

So the facility may charge a 99281 but the physician cannot ?


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## mitchellde

cpccoder2008 said:


> So the facility may charge a 99281 but the physician cannot ?



The facility may charge a level even though the physician cannot is a true statement!


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## vj_tiwari

Hey,

Thank you very much to all of you for your valuable help! 

VJ.


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## sam_son 

*Suture removal*

Hi Vj,

I am working for physician , We are using 99024 for patient who comes to ED for recheck with out any complications. 
I think you all know that 99024 is a "0" payment procedure, so we can use 99024 for suture removal in the CPT column. 

Regards


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## dorinda05

*Different physician in ER removing sutures than the physician who placed them in ER*

I fully understand everything that has been previously mentioned, I however, have one more thing that I need clarification on... The patient returns to the ER (within the 10 day global) for the suture removal, a DIFFERENT physician removes the sutures than who placed them. Is this still not chargeable when this happens or is it still global? I understand if it falls outside the 10 day global that it's billable.  Just confused if it's a different physician but same facility. Any feedback is appreciated!!!


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