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ED Coding and Reimbursement Alert

Reader Questions:

Use Modifier 54 Only When Follow-Up Is Certain

Published on Thu Feb 10, 2011

Question: A 17-year-old patient presents to the ED with a laceration on his 4 cm scalp He had fallen off his skateboard and hit his head. The nonphysician practitioner (NPP) performs a level-two ED E/M, and sees no sign of head trauma other than the laceration. The NPP then performs simple laceration repair using sutures. One of our physicians is insisting that we need to append modifier 54, "just in case the patient needs follow-up care for suture removal." I have never heard of billing a modifier 54 for a laceration repair. How should I code the encounter?South Dakota SubscriberAnswer: You do not need to add modifier 54 (Surgical care only) when follow-up care is uncertain. On the claim, report the following:12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) for the laceration repair99282 (Emergency [...]
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