# Suture Removal Under Anesthesia



## FTessaBartels (Oct 16, 2008)

We frequently take young children with facial sutures to the OR for suture removal under anesthesia. 

In this case, a 4-month-old infant, S/P repair of cleft lip and palate, was taken to the OR for suture removal (3 days after original surgery). However, before anesthesia was induced, the child exhibited tachycardia and SVT.  A Cardiology consult was obtained, and ultimately the decision was made to proceed with suture removal *without* anesthesia. All this was done in the OR. Following the procedure the baby was admitted to Pediatric Cardiology service. 

Can we code anything for the suture removal?

F Tessa Bartels, CPC, CPC-E/M


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## Anna Weaver (Oct 17, 2008)

*suture removal*

That's an interesting situation. I wonder if you could use a 52 for reduced services? But that wouldn't exactly be accurate either as the services weren't really reduced since the procedure was done, just not with anesthesia. I'm thinking you may not be able to charge. I know you were in the surgery suite, but if no anesthesia was done, I can't see what you could charge to capture this. Wow! What a great scenario for a test! LOL, if we can come up with the correct answer that is.


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## ARCPC9491 (Oct 22, 2008)

We had the same type of situation happen two days ago, except wasn't peds. 


whoops I totally gave the wrong CPT code... brain fart!!! I have wound care on the brain. I forgot what it was now... but we did use the 52 mod.


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## dmaec (Oct 22, 2008)

Morning Tessa - 
I don't believe you can charge for anything, in this scenario.  The suture removal would be within the global of the procedure.  I don't believe a .52 in this case is appropriate, and I don't believe a .73 would be either because what CPT would you even attach the modifier to?  The 15852 wouldn't work because it was a "removal" of sutures, not a dressing change.
hmm..I just don't see a charge in this one.


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## FTessaBartels (Oct 22, 2008)

*Global*

Everyone,
Thanks for your thoughts and comments. I was just too tired to think the day I sent in the question.  

After thinking about it, and reading all the chart notes, I came to the conclusion that this is NOT a billable service. Suture removal is global to the original procedure, UNLESS it's done under anesthesia. (They "papoosed" the baby to hold him still, poor little guy.)

Don't know if the hospital will be able to charge for use of the procedure room .. but that's not my concern ... I only code for the doc. 

Tessa


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## apmc (Jan 14, 2009)

*Looking for Further Discussion....*

Hello!
Instead of starting a new thread I thought I would post to this thread since my question has to do with this same scenario.
The original question did not state whether the physician was the original surgeon or not, but if he/she was not, I do believe that should have been billed and paid whether using a removal CPT or an E/M.

Anyway, my question is this:

I had read in a recent coding newsletter that you may bill 15851 (removal of sutures under anesthesia, other than local, other surgeon) with modifier -52 (reduced services) if the physician: 1) did not put the sutures in, 2) is not using anesthesia.  It goes on to state that ' Medicare won't pay this, but other carriers do.

I'm not sure if I feel comfortable about doing this as I was always told that suture removal w/out anesthesia should always be billed as an E/M. 

What's everyone else's thoughts on this?

Thanks for your help! Susan


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## mbort (Jan 14, 2009)

apmc said:


> Hello!
> Instead of starting a new thread I thought I would post to this thread since my question has to do with this same scenario.
> The original question did not state whether the physician was the original surgeon or not, but if he/she was not, I do believe that should have been billed and paid whether using a removal CPT or an E/M.
> 
> ...



Susan,
Can you tell us which publication you read that in so that we can perhaps research the source further?
Thanks
Mary, CPC,COSC


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## dmaec (Jan 14, 2009)

well, for us - we don't charge for suture removal within the global period.... if it's out of the global period, it's usually a very low E/M..with the V58.32 dx.  the same for if it wasn't one of our docs that placed the sutures, but we're taking them out - we charge typically, a low level E/M with V58.32.

but, that's just us...


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## TCarrasco (Jan 14, 2009)

*suture removal*

I would also like clarification on this! Our providers are usually not the ones who do the sutures, however patients do come in to our office to have them removed.(no anesthesia) In this case what is the correct way to code? Also, is there any difference in the way we should  code/bill being that we are a Community Health Center?


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## apmc (Jan 14, 2009)

*More info....*

Mary:
It was in the December 2008 issue of "Keep Up to Date on Internal Medicine Coding & Reimbursement".
Susan


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