When I scheduled my Mohs surgery, I was told that changes to insurance made it necessary for me to return the second day to get my stitches. If I was stitched up same day, does it mean insurance wouldn't cover that expense? That sounded strange to me as I would think there would be a liability issue to the doctor for dismissing me with an open wound. Now, I wonder if the doctor wasn't just trying to make more money by adding another office visit charge.
Why Did I Get Stitches Next Day After Mohs Surgery?
Doctor Answers 6
Did your Mohs surgeon do the repair, or did he send you to a Plastic Surgeon for repair? It could be that both surgeons could not coordinate their schedules for the same day. Insurance could be an issue. Check with your insurance company to see how they would answer that question.
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May be increase in reimbursement
I am not clear if the same doctor is closing the wound why it needs to be done on the second day. Sometimes when procedures are done on the different days they can be billed as two separate procedures. The insurance companies try to "bundle" procedures together. For example if you are an ophthalmologist and see a patient on a day and order a photo of their eye that day, the insurance company won't pay for the photo that day but will pay for it, if the photo is done on a separate day. You need to ask your Mohs Surgeon the specifics.
Delayed closure after surgical removal of cancer
Some physicians will delay closure of a defect that results after surgical removal of a cancer. This approach has been used for many years. In our practice, we typically close all defects the same day with a few rare exceptions. In any case, if you have confidence in your physician, then I am sure they are making a decision that is in your best interests.
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Mohs surgery repair varies with wound type and surgeon
Repair after Mohs surgery can happen in a variety of ways and for a variety of reasons:
1. Sometimes no repair is necessary -- the wound will heal on its own without stitches.
2. Often sutures are placed immediately after the tumor is cleared, with a linear repair, flap, or graft performed the same day.
3. The linear repair, flap, or graft can be delayed by several days or weeks to enhance its survival or appearance. Sometimes this is done to improve outcome, sometimes it is due to patient (or surgeon) fatigue and the need to continue on another day.
And then there is this reason: Due to the "multiple surgery reduction rule", the repair done on the same day as another surgery (excision or Mohs) is often only paid by the insurance company at a fraction of the true fee. This varies by company. Sometimes the amount paid is enough to cover the cost of supplies, time, etc... and sometimes it is not... so the doctor actually loses money for treating you.
Some offices require patients to return on a different day for repair after Mohs in order to collect the entire amount owed (and cover all costs of performing surgery), but it is a minority of practices that do this. Most perform what the patients need at the right time, usually the same day, regardless of the cost and the lack of reimbursement. But that's not a sustainable business practice, and it's getting harder to do.
No liablity issue with stitching next day after Mohs Surgery
There is no liability issue in dismissing a patient with an open wound to be repaired the next day. In fact some studies have shown that it helps skin graft survival to wait a week or two to let the wound heal a little on its own before placing the graft. There are certain wound locations that we actually allow to fill in on their own. I would recommend that you speak with the surgeon or the office manager of the practice as to the reason with respect to insurance.