Wiki Modifier 55

[dthompson@carolinamedical.us]

I just learned today that my coder informed the physicians they should not see patients to remove sutures which were done in the ER for simple lacerations, due to not getting paid. When I asked her about it she stated this was what she had always done. I thought that the physician office could bill for suture removal when the ER doctor told them to follow up with their PCP but would need to add a modifier 55. Can anyone help with this.

 

[Cynthia Hughes]

These services are typically included in an E/M service for evaluating how the wound is healing. CPT Assistant has directed to report an E/M (Dec. 2002). Some payers will limit use of modifier 55 to major procedures.