Wiki Suture Removal

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EricaR

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Received a denial on 15850, removal of sutures under anesthesia (other than local), same surgeon; this denial was from Cahaba GBA. Basically the denial states the code is not billable alone upon call to CSR i was advised it was like an add on code. I am trying to figure out if this will be paid on appeal if I do appeal, i did have a note in my pt account that this was billed last year, appealed, and we received a letter back stating this is not an appealable denial. Just wondering if anyone can give guidance on billing that procedure as I cannont locate anything in LCDs or Medicare Billing Manual. Thanks for any input.

- I should add that this patient is not in post op.

Erica :D
 
If you are using this code then you must have put them in and that is the code they are looking for on a previous claim. But you say the patient is not in a post op. I am confused then, why are you not in a post op for suture removal, and why are you doing it under general anesthesia.
 
Hi Debra,

He did put the stitches in, in 2009 during a hernia repair. The Dr. referred to it as a small stitch granuloma and due to the discomfort it was causing the pt he opted to perform removal under anesthesia.
 
I see what dx code did you use then I am homing in here on the correct code and I know what the problem is. I need to know everything you billed, and was this a retained suture, an embeded suture? as in did this miss being removed back in 09?
 
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