Primary Care Coding Alert

Question: A patient comes in with a benign lesion which requires excision and sutures. The patient returns a week later to have the sutures removed. Unfortunately, two days later, the wound reopens and requires more sutures. Can we bill for the resuturing? Is so, what code do we use?

Bobbie Copeland, Family Practice PA
Hitchcock, Texas

Answer: Barbara Gardner, CPC, billing specialist at Sunlife Family Healthcare Center, a single-physician practice in San Manuel, Ariz., suggests an FP code 11402 (excision, benign lesion, except skin tag [unless listed elsewhere], trunk, arms or legs; lesion diameter 1.1 to 2.0 cm). CPT defines excision as full-thickness (through the dermis) removal of a lesion and includes simple (non-layered) closure.

When the patient returns to have the sutures removed, Gardner recommends using 99024 (postoperative follow-up visit, included in global service). When the patient returns for resuturing, Gardner says, you cannot charge for an office visit but you would use 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).

Charlotte Davidson, CPC, CCS-P, office manager for Dennis O. Davidson, MD, in Batesville, Ark., agrees with the use of 11402. Removing the sutures is included in 11402 since the procedure occurred within the global period. If the patient has other problems besides the wound when she comes to the office, the FP also may charge for an office visit 99212-15 (office or outpatient visit for the evaluation and management of an established patient, which requires at least two of the three key components, ranging from a problem focused to a comprehensive history, a problem focused to a comprehensive examination and straightforward decision-making to one of high complexity).

Davidson notes that you cannot charge for an office visit unless the service was significant and separately identifiable. You may need to indicate this by adding modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

The resuture would require 12001* when its within the 10-day global period, but Davidson suggests adding modifier -58 (staged or related procedure or service by the same physician during the postoperative period). If the resuturing occurs after 10 days, modifier -58 is not necessary.