ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: When our physicians perform minor procedures, we report codes with modifier -54 because physicians instruct patients to follow up with their primary-care physicians for the suture removal. If the patient returns to the emergency department for suture removal, we report 99281 with the appropriate ICD-9 code. Is this coding correct? Kansas Subscriber  

Answer: Yes, you are technically correct. However, your approach leans toward conservative. Most practices report the laceration code without -54 (Surgical care only) and then remove the sutures for free.

If you apply your coding method across the board, you may run into some problems. For a starred procedure, say 12001* (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less), the relative value units apply only to the procedure, so a viable argument can be made that you don't need the -54. For a nonstarred procedure, however, your approach does fit, but most groups find it hard and cumbersome to track down a patient who comes back for a second visit.

As far as Medicare goes, you could defend your approach, but a global-surgery-package issue threatens your compliance. The global fee period for 99 percent of lacerations is 10 days, and the suture removals for all but distal lower extremities would take place within the global period.

So, the 99281 (Emergency department visit for the evaluation and management of a patient, which requires these three key components ...) you charge out could conflict with Medicare's global-surgery concept.