When You Can Charge and How
Many dermatologists have questions about when a practice can bill for wound care checks, dressing changes and suture removal. These questions become even more complex when practices “inherit” senior citizens who move into their areas for the winter months. “Snow birds,” as they are called, may live in New York part of the year while spending the other part in Arizona.
It is not uncommon for a patient to have a surgical service performed immediately before they transit to their alternate residence. For example, the dermatologist in New York performs the surgical service while the dermatologist in Arizona does the follow-up visits and removes the sutures. Can the physician in Arizona bill for the services provided, even though he or she did not do the actual surgery? What about regular surgical follow-up visits? Under what circumstances are postoperative visits billable? And which CPT and ICD-9 codes should be used when it is appropriate to bill for these services?
This article will address these types of questions so that your practice will not miss revenue when dressing changes and/or suture removal services are rendered and billable.
Q. Is there a CPT code for dressing change or suture removal that is reimbursed by insurance carriers?
A. A CPT code for postoperative follow-up visits does exist. It is 99024. However, this is not a reimbursed code by Medicare or any commercial carriers of which I’m aware. Most practices use this as an internal code to track “no-charge” visits.
What is most important to understand about billing for dressing changes or suture removal is whether or not there is a global follow-up period in place for the surgical service rendered. Many dermatologic services have a 10- or 90-day follow-up period included while others have no global surgical package.
Procedures such as biopsies (CPT codes 11100, 11101), shave removals (CPT codes 11300 through 11313), intralesional injections (CPT codes 11900, 11901, 96405, 96406), and Mohs (CPT codes 17311 through 17314) have no postoperative period. This means that if the patient requires a follow-up visit immediately after the procedure for services such as dressing changes, wound checks, and/or suture removal, the visit should be billed as an E/M visit. No modifiers should be needed on the E/M visit unless some other procedure is billed on the same date of service or there is a follow-up period in place because another unrelated surgical service was performed.
Q. If there is no global postoperative period, then what level of E/M visit should I bill?
A. That certainly depends on what was done and documented. In most cases, the visit would be a level one new patient visit (99201), level two established patient visit (99212), or nurse visit (99211) because only one body area is examined and the history and/or medical decision-making are minimal.
However, instances may arise when a visit turns into an extended visit because the patient needs to be counseled. This frequently happens when a patient returns for follow-up care and the pathology report is discussed. If the discussion turns into a 15- or 25-minute visit, the visit could be billed a 99213 or 99214 based on “time spent.” Obviously, the time must be clearly documented within the chart.
Q. When would a 99211 E/M visit be appropriate?
A. The 99211 E/M visit is a nurse visit and should only be used by medical assistant or nurse when performing services such as wound checks, dressing changes or suture removal. CPT code 99211 should never be billed for physician services. Additionally, if a medical assistant or a nurse charges 99211, a provider must always be on-site to provide direct supervision. CPT code 99211 cannot be charged to any third-party payer if there is no provider on site. The provider does not personally have to see the patient, but must be in the office suite. This is part of the incident-to guidelines.
Q. What ICD-9 code would be appropriate to use when billing postoperative visits?
A. You have a variety of choices:
1. Visits when the pathology results are discussed should be billed using the diagnosis on the pathology report.
2. Wound checks when there is a complication should be billed using the complication diagnosis code:
a. Infection — 998.59
b. Contact dermatitis — 692.9
c. Wound abscess — 998.59 d. Pain (NOS) — 780.96.
3. Dressing changes should be billed as follows:
a. Dressing change/removal of non-surgical wound — V58.30
b. Dressing change/removal surgical wound — V58.31.
4. Suture removal can be billed using V58.32.
Q. Do I need any modifiers appended to the E/M visit?
A. If there is no postoperative period in place, no modifiers need to be appended to the E/M visit.
If there is a postoperative complication that requires a visit, then modifier -24 must be used. However, the vast majority of insurance carriers, including Medicare, will not pay for any E/M visits during the postoperative period, even if there is a complication such as an infection. Most carriers will deny the service. If such a denial occurs, an appeal or claim redetermination could be performed, although, in most instances, the carriers will not reverse their initial denial decision.
If there is no postoperative period in effect, but a procedure is also billed on the same date of service, modifier -25 must be attached to the E/M visit.
Q. What if the patient just comes in for suture removal when the surgery was performed by another practice? Can I bill if the follow-up visit is billed during the postoperative period? How do I bill? Do I use the -54 or -55 modifiers?
A. Absolutely, you should bill for the services you provide. In most instances, you won’t even know what CPT code was billed by the surgeon, how many postoperative days the procedure has, or how many postoperative days still remain. Because you are in a different practice, you are not subject to the follow-up or global period of the other provider (e.g., performing surgeon).
Here are some guidelines:
1. If the patient is new to your practice, you may use 99201-99203 depending on the level of care rendered, degree of documentation, or the amount of time spent counseling.
2. If the patient is an established patient, you may use 99211-99215 depending on the level of care rendered, degree of documentation, or the amount of time spent.
3. The visit is rarely just a suture removal encounter. Even if sutures are removed, the wound site is usually evaluated for infection, healing, erythema, edema, etc. The absence or presence of these symptoms should be noted in the chart. Additionally, wound care instructions are usually given and/or reiterated during the encounter. The provision of these instructions should also be noted in the chart. And, it is not uncommon for the patient to ask questions about the diagnosis, prognosis, or degree of risk. In these situations, the length of time spent should be noted.
The documentation of the above issues then justifies that evaluation and management services were rendered and are significant and separately identifiable.
Do not use any modifiers such as -54 or -55 as they are not appropriate for the scenarios discussed above.
Q. If I have a group practice and one of my colleagues does the follow-up for dressing changes, wound care checks, or suture removal for a surgical service I performed, can the visit be charged since he/she is not the same provider who performed the surgery?
A. No, your colleague cannot bill. He/she is subject to the same global surgical follow-up period because you are all part of the same practice. Billing for these visits would be unbundling and could be construed as fraud.
When You Can Charge and How
Many dermatologists have questions about when a practice can bill for wound care checks, dressing changes and suture removal. These questions become even more complex when practices “inherit” senior citizens who move into their areas for the winter months. “Snow birds,” as they are called, may live in New York part of the year while spending the other part in Arizona.
It is not uncommon for a patient to have a surgical service performed immediately before they transit to their alternate residence. For example, the dermatologist in New York performs the surgical service while the dermatologist in Arizona does the follow-up visits and removes the sutures. Can the physician in Arizona bill for the services provided, even though he or she did not do the actual surgery? What about regular surgical follow-up visits? Under what circumstances are postoperative visits billable? And which CPT and ICD-9 codes should be used when it is appropriate to bill for these services?
This article will address these types of questions so that your practice will not miss revenue when dressing changes and/or suture removal services are rendered and billable.
Q. Is there a CPT code for dressing change or suture removal that is reimbursed by insurance carriers?
A. A CPT code for postoperative follow-up visits does exist. It is 99024. However, this is not a reimbursed code by Medicare or any commercial carriers of which I’m aware. Most practices use this as an internal code to track “no-charge” visits.
What is most important to understand about billing for dressing changes or suture removal is whether or not there is a global follow-up period in place for the surgical service rendered. Many dermatologic services have a 10- or 90-day follow-up period included while others have no global surgical package.
Procedures such as biopsies (CPT codes 11100, 11101), shave removals (CPT codes 11300 through 11313), intralesional injections (CPT codes 11900, 11901, 96405, 96406), and Mohs (CPT codes 17311 through 17314) have no postoperative period. This means that if the patient requires a follow-up visit immediately after the procedure for services such as dressing changes, wound checks, and/or suture removal, the visit should be billed as an E/M visit. No modifiers should be needed on the E/M visit unless some other procedure is billed on the same date of service or there is a follow-up period in place because another unrelated surgical service was performed.
Q. If there is no global postoperative period, then what level of E/M visit should I bill?
A. That certainly depends on what was done and documented. In most cases, the visit would be a level one new patient visit (99201), level two established patient visit (99212), or nurse visit (99211) because only one body area is examined and the history and/or medical decision-making are minimal.
However, instances may arise when a visit turns into an extended visit because the patient needs to be counseled. This frequently happens when a patient returns for follow-up care and the pathology report is discussed. If the discussion turns into a 15- or 25-minute visit, the visit could be billed a 99213 or 99214 based on “time spent.” Obviously, the time must be clearly documented within the chart.
Q. When would a 99211 E/M visit be appropriate?
A. The 99211 E/M visit is a nurse visit and should only be used by medical assistant or nurse when performing services such as wound checks, dressing changes or suture removal. CPT code 99211 should never be billed for physician services. Additionally, if a medical assistant or a nurse charges 99211, a provider must always be on-site to provide direct supervision. CPT code 99211 cannot be charged to any third-party payer if there is no provider on site. The provider does not personally have to see the patient, but must be in the office suite. This is part of the incident-to guidelines.
Q. What ICD-9 code would be appropriate to use when billing postoperative visits?
A. You have a variety of choices:
1. Visits when the pathology results are discussed should be billed using the diagnosis on the pathology report.
2. Wound checks when there is a complication should be billed using the complication diagnosis code:
a. Infection — 998.59
b. Contact dermatitis — 692.9
c. Wound abscess — 998.59 d. Pain (NOS) — 780.96.
3. Dressing changes should be billed as follows:
a. Dressing change/removal of non-surgical wound — V58.30
b. Dressing change/removal surgical wound — V58.31.
4. Suture removal can be billed using V58.32.
Q. Do I need any modifiers appended to the E/M visit?
A. If there is no postoperative period in place, no modifiers need to be appended to the E/M visit.
If there is a postoperative complication that requires a visit, then modifier -24 must be used. However, the vast majority of insurance carriers, including Medicare, will not pay for any E/M visits during the postoperative period, even if there is a complication such as an infection. Most carriers will deny the service. If such a denial occurs, an appeal or claim redetermination could be performed, although, in most instances, the carriers will not reverse their initial denial decision.
If there is no postoperative period in effect, but a procedure is also billed on the same date of service, modifier -25 must be attached to the E/M visit.
Q. What if the patient just comes in for suture removal when the surgery was performed by another practice? Can I bill if the follow-up visit is billed during the postoperative period? How do I bill? Do I use the -54 or -55 modifiers?
A. Absolutely, you should bill for the services you provide. In most instances, you won’t even know what CPT code was billed by the surgeon, how many postoperative days the procedure has, or how many postoperative days still remain. Because you are in a different practice, you are not subject to the follow-up or global period of the other provider (e.g., performing surgeon).
Here are some guidelines:
1. If the patient is new to your practice, you may use 99201-99203 depending on the level of care rendered, degree of documentation, or the amount of time spent counseling.
2. If the patient is an established patient, you may use 99211-99215 depending on the level of care rendered, degree of documentation, or the amount of time spent.
3. The visit is rarely just a suture removal encounter. Even if sutures are removed, the wound site is usually evaluated for infection, healing, erythema, edema, etc. The absence or presence of these symptoms should be noted in the chart. Additionally, wound care instructions are usually given and/or reiterated during the encounter. The provision of these instructions should also be noted in the chart. And, it is not uncommon for the patient to ask questions about the diagnosis, prognosis, or degree of risk. In these situations, the length of time spent should be noted.
The documentation of the above issues then justifies that evaluation and management services were rendered and are significant and separately identifiable.
Do not use any modifiers such as -54 or -55 as they are not appropriate for the scenarios discussed above.
Q. If I have a group practice and one of my colleagues does the follow-up for dressing changes, wound care checks, or suture removal for a surgical service I performed, can the visit be charged since he/she is not the same provider who performed the surgery?
A. No, your colleague cannot bill. He/she is subject to the same global surgical follow-up period because you are all part of the same practice. Billing for these visits would be unbundling and could be construed as fraud.
When You Can Charge and How
Many dermatologists have questions about when a practice can bill for wound care checks, dressing changes and suture removal. These questions become even more complex when practices “inherit” senior citizens who move into their areas for the winter months. “Snow birds,” as they are called, may live in New York part of the year while spending the other part in Arizona.
It is not uncommon for a patient to have a surgical service performed immediately before they transit to their alternate residence. For example, the dermatologist in New York performs the surgical service while the dermatologist in Arizona does the follow-up visits and removes the sutures. Can the physician in Arizona bill for the services provided, even though he or she did not do the actual surgery? What about regular surgical follow-up visits? Under what circumstances are postoperative visits billable? And which CPT and ICD-9 codes should be used when it is appropriate to bill for these services?
This article will address these types of questions so that your practice will not miss revenue when dressing changes and/or suture removal services are rendered and billable.
Q. Is there a CPT code for dressing change or suture removal that is reimbursed by insurance carriers?
A. A CPT code for postoperative follow-up visits does exist. It is 99024. However, this is not a reimbursed code by Medicare or any commercial carriers of which I’m aware. Most practices use this as an internal code to track “no-charge” visits.
What is most important to understand about billing for dressing changes or suture removal is whether or not there is a global follow-up period in place for the surgical service rendered. Many dermatologic services have a 10- or 90-day follow-up period included while others have no global surgical package.
Procedures such as biopsies (CPT codes 11100, 11101), shave removals (CPT codes 11300 through 11313), intralesional injections (CPT codes 11900, 11901, 96405, 96406), and Mohs (CPT codes 17311 through 17314) have no postoperative period. This means that if the patient requires a follow-up visit immediately after the procedure for services such as dressing changes, wound checks, and/or suture removal, the visit should be billed as an E/M visit. No modifiers should be needed on the E/M visit unless some other procedure is billed on the same date of service or there is a follow-up period in place because another unrelated surgical service was performed.
Q. If there is no global postoperative period, then what level of E/M visit should I bill?
A. That certainly depends on what was done and documented. In most cases, the visit would be a level one new patient visit (99201), level two established patient visit (99212), or nurse visit (99211) because only one body area is examined and the history and/or medical decision-making are minimal.
However, instances may arise when a visit turns into an extended visit because the patient needs to be counseled. This frequently happens when a patient returns for follow-up care and the pathology report is discussed. If the discussion turns into a 15- or 25-minute visit, the visit could be billed a 99213 or 99214 based on “time spent.” Obviously, the time must be clearly documented within the chart.
Q. When would a 99211 E/M visit be appropriate?
A. The 99211 E/M visit is a nurse visit and should only be used by medical assistant or nurse when performing services such as wound checks, dressing changes or suture removal. CPT code 99211 should never be billed for physician services. Additionally, if a medical assistant or a nurse charges 99211, a provider must always be on-site to provide direct supervision. CPT code 99211 cannot be charged to any third-party payer if there is no provider on site. The provider does not personally have to see the patient, but must be in the office suite. This is part of the incident-to guidelines.
Q. What ICD-9 code would be appropriate to use when billing postoperative visits?
A. You have a variety of choices:
1. Visits when the pathology results are discussed should be billed using the diagnosis on the pathology report.
2. Wound checks when there is a complication should be billed using the complication diagnosis code:
a. Infection — 998.59
b. Contact dermatitis — 692.9
c. Wound abscess — 998.59 d. Pain (NOS) — 780.96.
3. Dressing changes should be billed as follows:
a. Dressing change/removal of non-surgical wound — V58.30
b. Dressing change/removal surgical wound — V58.31.
4. Suture removal can be billed using V58.32.
Q. Do I need any modifiers appended to the E/M visit?
A. If there is no postoperative period in place, no modifiers need to be appended to the E/M visit.
If there is a postoperative complication that requires a visit, then modifier -24 must be used. However, the vast majority of insurance carriers, including Medicare, will not pay for any E/M visits during the postoperative period, even if there is a complication such as an infection. Most carriers will deny the service. If such a denial occurs, an appeal or claim redetermination could be performed, although, in most instances, the carriers will not reverse their initial denial decision.
If there is no postoperative period in effect, but a procedure is also billed on the same date of service, modifier -25 must be attached to the E/M visit.
Q. What if the patient just comes in for suture removal when the surgery was performed by another practice? Can I bill if the follow-up visit is billed during the postoperative period? How do I bill? Do I use the -54 or -55 modifiers?
A. Absolutely, you should bill for the services you provide. In most instances, you won’t even know what CPT code was billed by the surgeon, how many postoperative days the procedure has, or how many postoperative days still remain. Because you are in a different practice, you are not subject to the follow-up or global period of the other provider (e.g., performing surgeon).
Here are some guidelines:
1. If the patient is new to your practice, you may use 99201-99203 depending on the level of care rendered, degree of documentation, or the amount of time spent counseling.
2. If the patient is an established patient, you may use 99211-99215 depending on the level of care rendered, degree of documentation, or the amount of time spent.
3. The visit is rarely just a suture removal encounter. Even if sutures are removed, the wound site is usually evaluated for infection, healing, erythema, edema, etc. The absence or presence of these symptoms should be noted in the chart. Additionally, wound care instructions are usually given and/or reiterated during the encounter. The provision of these instructions should also be noted in the chart. And, it is not uncommon for the patient to ask questions about the diagnosis, prognosis, or degree of risk. In these situations, the length of time spent should be noted.
The documentation of the above issues then justifies that evaluation and management services were rendered and are significant and separately identifiable.
Do not use any modifiers such as -54 or -55 as they are not appropriate for the scenarios discussed above.
Q. If I have a group practice and one of my colleagues does the follow-up for dressing changes, wound care checks, or suture removal for a surgical service I performed, can the visit be charged since he/she is not the same provider who performed the surgery?
A. No, your colleague cannot bill. He/she is subject to the same global surgical follow-up period because you are all part of the same practice. Billing for these visits would be unbundling and could be construed as fraud.
