ED Coding and Reimbursement Alert

Question: When should I bill for suture removal? When shouldn't I?

Idaho Subscriber

Answer: With the deletion of the starred procedure concept (*), a change that took effect in January 2004, suture removals are now considered part of typical post-operative care. As such, they're bundled into the original procedure, such as 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) or 12051 (Layer closure of wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 2.5 cm or less).

If an emergency department physician from a different group placed the sutures, you can bill the removal using a low-level evaluation and management code, usually 99281 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making).

Before January 2004, a star next to a procedure code indicated that the code included only the surgical procedure and did not include any relevant E/M services or ancillary services. The removal of this concept from CPT codes means that the procedure code includes all ancillary services during the procedure's global period. For more information on when you can and can't bill these services, see "Don't Let Starless Codes Deter Separately Reporting an E/M" in the January 2004 issue of ED Coding Alert.