Wiki Need help with a code-deep suture removal

[awillson]

My physician is doing a deep suture removal (prolene sutures in the 6R and 6U portals and wants to bill 20680 removal of hardware. I don't agree with this and feel that he should be using 15850 (suture removal under anesthesia same surgeon) as he was the same surgeon that put them in when he did the initial repair. Am I wrong in using 15850 as I feel that actual hardware would need to be removed in order to use 20680?

Thanks for you help.

awillson

 

[rdodom]

This falls into one of those "grey areas" to say the least. The suture removal requires more work than 15850 (Wrvu=0.78) and perhaps less work than 20680(Wrvu=5.9)

If we go back and look at the "Intent" of the code(s) definition, one possible solution would be to submit the 15850 code, appending a Modifier 22, and sending the Op Report of the procedure. This perhaps will satisfy the surgeon and allow you to sleep a little better.

 

[awillson]

Thank you. I do feel better knowing that I do have someone that agrees with me. I will discuss the 22 modifier further with my physician to see if this will help. Thank you so much.