ED Coding and Reimbursement Alert

Question: Our ED physician saw a patient for a suture repair and told her to come back in two days for recheck. She came back in two days and saw a different ED physician. Would there be a charge for that second visit?

California Subscriber

Answer: CPT language supports using an E/M for a wound check following a starred procedure. For non-starred procedures, look to the introduction to the surgery section, which lists bundled services with the surgical package to include typical follow-up care. Determine whether the wound check represents typical follow-up care on a case-by-case basis. Medicare will not recognize an E/M during the 10-day global following a suture repair for a wound check.

Your billing depends on the payer and whether it recognizes the starred-procedure designation. Because CPT states that postoperative care is not part of the non-starred service, as long as a physician sees the patient you should at least consider assigning an E/M code to this service, even if the same physician treated the patient.

Some practices elect not to bill these suture repairs. However, it is a legitimate choice for those that do choose to bill out this service.