Otolaryngology Coding Alert

Question: If residents under my supervision in the emergency department repair a laceration, should I bill for the laceration repair if the patient has private insurance? If I do not bill the repair but see the patient in my office, can I bill for the E/M visit and suture removal?

Iowa Subscriber

Answer: A teaching otolaryngologist can bill for the closure only if he or she was in the room while the resident performed it. The otolaryngologist has to be physically present where the resident performs the procedure. If that is the case, commercial and Medicare carriers may be billed. But if the otolaryngologist was not present, Medicare carriers and private payers will not reimburse the service.

Because laceration repairs typically have 10-day global periods, if the teaching otolaryngologist was present and bills for the repair, any E/M performed within 10 days of the original procedure is not payable separately. But if the teaching otolaryngologist was not present and does not bill for the service, any subsequent visits with the patient during the global period should be billed using the appropriate E/M code.

There is no code for suture removal, which CPT, in any case, considers part of the repair. If the otolaryn-gologist removes sutures placed by another physician (including the resident, if the otolaryngologist was not present and therefore did not bill for the laceration repair), a low-level new or established patient code may be billed.