Ophthalmology and Optometry Coding Alert

Question: Can we code for suture removal when our ophthalmologist isn’t the physician who placed the sutures? If so, which code should we use?

Michigan Subscriber

Answer: You should submit either established or new patient office visit codes, depending on whether your ophthalmologist has seen the patient within the last three years.

For a new patient, report a code from 99201-99205 (Office visit for the evaluation and management of a new patient …), based on the service level, and choose from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) for an established patient.

Your diagnosis code would be V58.32 (Encounter for removal of sutures).

Caveat: You shouldn’t have a problem getting paid if the two physicians are not in the same group or practice. If they are in the same group or practice, you should not report the suture removal. In this case, if your ophthalmologist wants to seek payment for the suture removal, you’ll need to figure the payment split on the back end.