Nurse visit denial

We submitted a claim to Tufts Health Plan for a nurse visit for suture removal; the sutures had been placed elsewhere. I used the DX codes for the suture removal and the correct injury code. We also gave the patient a flu shot. For CPT® codes I used 99211-25, 90471 and 90658. The insurer denied the 99211 stating it was part of a major procedure. Can you tell me if this is correct?

S0630

for suture removal if your doc did not place them. if you billed to place them then you cannot bill to remove them.

Nurse visit denial

We did not bill to place the sutures; injury was treated at an out-of-town ER

nurse visit denial

this claim was denied in error they are trying to include this visit in with the major procedure that the patient had somewhere else, what you can due is send this claim back for reconsideration with the medical notes attached.

Nurse visit

Code 99211 is a component of Column 1 code 90471 and cannot be billed using any modifier. This is per the NCCI edits.