Wiki Stitch Removal

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If your physician did not put the sutures in, then you should bill an E&M code with no modifier. If that is getting denied, you need to appeal it.
 
What level E/M are you billing? I would only bill a 99211 for suture removal with V58.32. If that is what you are billing and you are receiving a denial I would appeal. In your appeal letter I would state that your physician did not place the sutures and s/he should be compensated for their time and services. You can find information regarding this topic in Family Practice Management Journal July/August 1999 and March 2000. I wouldn't bill any higher level because the provider isn't performing an exam, history or doing MDM for a suture removal. If the provider is doing that and you are coding a higher level be sure it is clearly documented as well as the medical necessity.
 
I think a 99212 would be medically necessary and easy to document. The provider has to get a history about the injury, examine the wound, and remove the sutures. Right there you have a problem focused history and exam and straightforward MDM.
 
Our providers usually bill a 99212. We do not use a modifier. Our providers always do an exam to make sure not infected, etc. We don't just have the nurse remove the stitches without a provider doing an E/M.
 
It's odd that you are getting global denials. Are you sure it wasn't a doctor in your group that did the original procedure?

Global denials would apply if you are billing for the physician or another physician in the same group practice who did the original procedure.


:) Erica
 
What about HCPCS code for suture removal? S0630 is removal of sutures by a physician other than the physician who originally closed the wound (not paid by medicare but many other carriers allow). I would bill E&M with this code and no modifiers. Does anybody else have suggestions on how to bill using the HCPCS code?
 
suture removal

Has anyone tried using 99024? Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for reason(s) related to the original procedure. Perhaps use this procedure code w/o any E/M code at all? Although I'm not really sure how the billing and reimbursement side view this code? Should it only be used with major surgical procedure f/u visits?
 
The S codes are used by the Blue Cross/Blue Shield Association (BCBSA) and the Health Insurance Association of America (HIAA) to report drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. They are for the purpose of meeting the particular needs of the private sector. These codes are also used by the Medicaid program, but they are not payable by Medicare.
 
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