ED Coding and Reimbursement Alert

Question: When we suture a patient in the emergency center, we encourage them to follow up with their primary-care doctor, if they have one. If they choose to return to the ED for suture removal, is it OK to charge an E/M service for this visit? Some people seem to think that the follow-up care is bundled with the suture charge, but the CPT book indicates that many of the suture charges to which I am referring are starred procedures.

Anonymous TX subscriber

Answer: Even though CPT defines many laceration repairs as starred procedures (indicating surgical service only), which indicates that postoperative care can be billed separately, most insurance carriers apply a 10-day global period to these codes, says Callaway-Stradley. Suture removal would be included in the global fee for these codes and should not be billed separately.

Medicare, in particular, does not recognize starred surgical procedures, notes Bartels. Medicare divides the surgical codes into major and minor procedures and assigns a global period to all of the codes. This may range from zero to 60 days, and many laceration repair codes have the 10-day period, as Callaway-Stradley noted. However, if a payer recognized starred procedures listed in CPT and did not apply a global period, that would mean the laceration repair code would indicate the surgical service only and suture removal could be reported separately, he says.

In that case, provided the physician documentation supported the level of history and examination, we would bill a 99281 (emergency department visit for the evaluation and management of a patient), Bartels says.

But, many physician groups choose not to charge for suture removal and provide it as a courtesy to patients, he adds. About 50 percent of our clients do this.

Note: Bill the appropriate E/M level that the physician documentation supports; do not automatically bill 99281.