Mountain State Medical Policy Bulletin
Section: Surgery
Number: S-61
Topic: Removal of Sutures
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

The allowance for suturing of lacerations normally includes post-operative care plus the removal of sutures. Therefore, when the physician who performed the suturing reports a separate charge for the removal of the sutures, the charges should be combined and payment should be based on the allowable charge for the suturing.

Suturing of a surgical wound and removal of the sutures are included in the fee for the surgery performed.

Charges submitted for removal of sutures by a physician (or his associate/partner) other than the physician who performed the suturing should be denied, with the following exceptions:

  1. Coverage for removal of sutures is determined according to individual or group customer benefits.
  2. Payment also may be made when both the member's agreement provides emergency follow-up care after emergency accident services and when any limitations (time, etc.) under that benefit are met (see codes 99212, 99281, 99311, 99331, 99347).

Procedure Codes

158501585199212992819931199331
99347S0630    

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

When unusual circumstances require removal of sutures by a physician other than the one who applied them, a separate allowance may be paid.

Also refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

12/2004, Closures following surgery considered part of the global surgery allowance

References

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.