“Since the global period for a toe amputation is now zero days, does that mean I bill for removing sutures in the office when I do a follow up visit in 14 days? Billing for this, seems very uncomfortable to me.”
Kudos to the physician that posted this scenario! It appears that instead of trying to figure out the best way to bill for something, this physician wants to do it correctly.
As of January 1, 2021, two CPT codes that are certainly utilized by podiatrists underwent a significant change. The two CPT codes are 28820 and 28825.
CPT code 28820 is defined as: Amputation, toe; metatarsophalangeal joint
CPT code 28825 is defined as: Amputation, toe; interphalangeal joint
The change that affected both of these CPT codes was a reduction in the postoperative global period from 90 days to 0 days. Unfortunately, not only was the global period reduced, but so was the reimbursement.
The question that was posted has to do with the removal of the sutures at the postoperative visit at day number 14. Can the removal of the sutures be billed for? Well, in a word the answer is no. Being blunt and to the point, when the procedure was performed, the suturing of the surgical site is not separately reimbursable. It is considered to be part of the procedure. The surgeon put them in. The surgeon takes them out. There is not an additional reimbursement at either end. Comparing this to two other procedures that have a 0 day postoperative global period:
1. If a punch biopsy is performed of a questionable lesion and the biopsy site is sutured, there is not an additional reimbursement for putting the sutures in or removing them postoperatively.
2. If a nail biopsy is performed and the biopsy site within the nail bed needs to be sutured and closed, there is not an additional reimbursement for putting the sutures in or removing them postoperatively.
The next question should be: if either CPT codes 28820 or 28825 are performed, what can be billed postoperatively? Well, it all comes down to two very, important words, MEDICAL NECESSITY. Just following up the patient postoperatively does not qualify to bill for that encounter. Now, if something occurs necessitating treatment above and beyond the normal postoperative course of events, based upon the documentation in the medical record, this could possibly lead to the billing of an E/M service, a CPT/procedure code, or perhaps both.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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