Primary Care Coding Alert

Question: A patient dropped a 25-pound bag of salt on her right foot. She went to the urgent care clinic and received six stitches in the third digit and was diagnosed with fractured third and fourth digits, as well. She came to us three days later, at which time we ordered crutches along with antibiotics and pain medication. Four days later she returned for the suture removal and three days later we saw her for an infection of that wound. How do I code these visits?

Pennsylvania Subscriber

Answer: It is appropriate for your practice to charge E/M codes for the visits, each at a level that reflects the service documented in the patient record. The fracture care code describes the services provided at the urgent care center. Your practice, however, is allowed payment for the services it rendered as well. You would assign the diagnosis code for the fractured toes for the first office visit (i.e., 826.0, fracture of one or more phalanges of foot; closed) and an ICD-9 code identifying suture removal for the second office visit (i.e., V58.3, attention to surgical dressings and sutures). For the office visit where the infected wound was treated, consider 998.59 (postoperative infection, other postoperative infection).

Coders should be aware that there is no specific procedure code describing suture removal because it is included in the surgical package and not billed separately. Generally, 99211 is reported when a nurse removes stitches that were placed by another physician in another practice, while 99212 may be assigned when a physician performs the service under similar circumstances.