Wiki still global if we didn't perform the surgery?

[avrilw]

If a patient has a couple lesions removed by a dermatologist and they come in to our office 8 days later for a suture removal, can we bill for this service? We are not related in any way to the derm office and have seperate NPI's and tax ID's.
Thanks

 

[mitchellde]

The question is why did the patient return to your office for the suture removal and not the derm office. In order to bill post op care for a different provider you must have a transfer of care authorization from the referring surgeon. Those sutures are his and only the surgeon that put them in can determine if any other provider may remove them. If the surgeon's intent was for the patient to return to his office for post op then he billed global , so the payer has already paid to remove them
If you have a transfer of care from the surgeon then you bill using the same procedure code the surgeon use and append the 55 modifier and use the V58.83 dx code.. if the patient self refers to your office with no transfer of care then you need to bill the patient since the payer has already paid for the post op care.

 

[OCD_coder]

To a certain degree I agree with Debra, most surgeons should be doing the postop care and removing the sutures. The dermatologist would really like to see that patient. I like the suggestion that the provider removing the sutures asked why they are not returning to the surgeon.

A transfer is care is not a requirement by any provider or carrier. The patient has discretion on who they seek care from. This would be a low level E&M per the examples in the CPT manual by the AMA.

If the sutures are placed by an ER physician, there won't be "transfer of care" and it would be inappropriate and very expensive for a patient to return to the ER to have them removed.

V58.32 Removal of sutures

V58.83 Encounter for therapeutic monitoring of drug