Pediatric Coding Alert

Question: A child on Medicaid comes in to have stitches removed that an emergency department (ED) physician placed. Should we report an E/M code or S0630?


Georgia Subscriber


Answer: Because another physician performed the repair, you are correct in billing for the suture removal.

You should report the suture removal by another physician other than the doctor who placed the stitches with the appropriate E/M code (such as 99212-99213, Office or other outpatient visit for the evaluation and management of an established patient ...).

For the primary suture removal diagnosis, report V58.3 (Encounter for other and unspecified procedures and aftercare; attention to surgical dressings and sutures [removal of sutures]). Use the ICD9 Codes that represents the wound type as the secondary diagnosis. For instance, if the child had a forehead wound, you would assign 873.42 (Other open wound of head; face, without mention of complication; forehead) in addition to V58.3.

Georgia Medicaid does not accept the HCPCS suture removal S code (S0630, Removal of sutures by a physician other than the physician who originally closed the wound). If you have this scenario occur with a patient on Blue Cross Blue Shield or with an out-of-state Medicaid beneficiary, check with the insurer for its S0630 policy. When you do use this code, do not also report an E/M service, unless the pediatrician provides a significant, separately identifiable service.

Tip: You may use 99211 if a nurse removes the stitches. If a pediatrician removes the stitches, choose the E/M code based on the service the physician provides and documents.

Watch out: Don't use a repair code, such as 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 pediatrician or nurse is removing the stitches, not repairing the laceration.