Wiki suture removal-Good Morning

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paula f3

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Good Morning
I have a Medicare patient who had a mass excision, post op had to return to the OR for suture removal under anesthesia due to pt extreme anxiety and pain. I coded 15850-78, Medicare has denied and stating that we are unable to appeal or bill patient. Bottom line thinking that we should have gotten ABN signed by patient. Is this correct?
Thank you
Paula
 
No one is paying this anymore

Well .. maybe there is a payor out there who will cover this, but the government payers, BCBS/Anthem, and United Healthcare are all denying this as global. You put the sutures in, You have to take them out.

They ARE paying the anesthesiologist and the facility fees, but not paying the surgeon.

I code for pediatric craniofacial surgeons (i.e. plastic reconstructive surgery). We take many of our patients with facial sutures to the OR ... they're too young to sit still and restraining them is traumatic. Our op notes clearly outline the medical necessity for taking them back to the OR for suture removal under anesthesia, but for the past year or so no luck in appealing these.

Good luck

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
We are the facility, I do understand their rationale by not reimbursing the physician, but the facility. When our bill called Medicare they informed her that this a procedure they never reimburse. Im completely dumbfounded

Paula
 
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