Ophthalmology and Optometry Coding Alert

Normally, the surgeon who does a corneal transplant does not bill for removing suturesif the sutures even need to be removed. However, the world of coding is replete with situations that fall outside the norm.

Lets say a patient must be under anesthesia to have the sutures removed. This means a return to the operating room, quite possibly during the postoperative period. Can the surgeon get paid for removing the sutures? Its unlikely, unless the patient has general anesthesia for the removal.

General Anesthesia

If the patient has general anesthesia for the suture removal, there is a code you can use, says Raequell Duran, president of Practice Solutions, an ophthalmology billing and reimbursement consulting firm based in Bakersfield, Calif. The code is 92018 (ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete) 92019 (limited).

You could then append modifier -78 (return to the operating room for a related procedure during the postoperative period) to 92018 if the suture removal is done during the global period, or just use 92018 if the suture removal is done outside of the global period. You would use the same diagnosis codecornea transplant (V42.5)that you would for the original operation.

Note: You cant use wound revision (66250) for this suture removal, regardless of how much you may be tempted to do so. The Medicare Carriers Manual (MCM) says that the global surgical package includes removal of cutaneous sutures and staples. In ophthalmology, this would include suture removal.

Scenarios To Avoid

Sue Vicchrilli, COT, an ophthalmic coding specialist for the American Academy of Ophthalmology, says, There isnt a code for removing sutures. Technically, if there were a code, you would file for it with the -78 modifier, she says. (This would be used if the procedure were done during the postoperative global period).

But Vicchrilli says most claims wont get paid this way. There is simply no code to which a coder could append the modifier. Suture removal, by CPT principle, is covered in the global fee for the original surgery, even if the sutures would normally not be removed.

Ramona Cosme, president of Ramco Billing, an ophthalmology billing and compliance consulting firm based in Edison, N.J., agrees. Its my impression that if a patient has a cornea transplant and later presents with a complication, thats part of the global, she says. Even if the complication arises a year laterway past the global periodyou still cant bill.

Lets say the patient starts having discomfort because of a suture, and the ophthalmologist needs to remove or adjust the suture: There is no way to bill for it. Sometimes that patient has rubbed a suture loose. There is no way to charge for fixing it.

Whether its laser suture lysis, or suture removal, or anything that has to do with suture adjustments, its all included in the global fee, she says.

This is not so much of a problem, presumably, if the surgeon who did the transplant is the one who removes the suture. Whoever put it in, should take it out, notes Cosme. If, however, the patient has moved or has switched doctors, the new ophthalmologist is not going to be paid for doing the removal.

If the removal or adjustment is done in the office, an office-visit code could, of course, be charged. The problem with coding for the procedure in the operating room is that there is no procedure code for suture removal.

The only way you could bill for the surgery is if the patient goes in for something thats non-related to the cornea transplant, says Cosme. Then, its a different scenario altogether. If the patient presents with a different problem in addition to the suture, the doctor can bill for the other problem.