General Surgery Coding Alert

Here's why 15850-15851 with modifier 52 is not an option

Reporting suture removal procedures is tricky -- especially because you won't find many codes for this service. Follow these basic scenarios that will allow you to claim these services with confidence.

Option 1: Honor the -Global- Concept

If the same physician who placed the sutures removes them during the global period of the original procedure, you cannot report the removal separately.
 
Example: The patient underwent a laceration repair eight days ago for a 5-cm cut on her scalp. The original procedural code, 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm), already includes the suture removal.

-Laceration repair codes (12001-13153) that would require a suture removal have a 10-day global period,- says Linda S. Templeton, CPC, coding consultant for The Rybar Group Inc. in Fenton, Mich. Therefore, if the patient comes in within that global period, you can't report the suture removal separately because it's already a part of the global service.
 
Other procedures that involve suture removal include major surgeries, which carry a 90-day global, Templeton says. -So for any other occasion, you wouldn't typically come across a scenario where you would consider reporting the suture removal separate from the primary procedure.-
 
Tip: You can't report it to your payer, but 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a post-operative period for a reason[s] related to the original procedure) is valid for covering suture removal and is good for tracking.
 
Although it has a zero charge, you can use 99024 to keep track of visits for risk management purposes to show that the patient did present for a follow-up visit within the surgical period, Templeton says.

Option 2: Report 15850 or 15851

If you must place a patient under general anesthesia for suture removal, you may be able to report the service separately using 15850 (Removal of sutures under anesthesia [other than local], same surgeon) or 15851 (Removal of sutures under anesthesia [other than local], other surgeon).
 
Example: A patient received sutures for a serious wound, and skin has grown over the sutures, requiring a complex suture removal. The same surgeon who placed the sutures returns the patient to the OR and places her under general anesthesia to remove the sutures. In this case, you may report 15850.
 
Avoid this mistake: You shouldn't append 15850 or 15851 with modifier 52 (Reduced services) to get paid for suture removal without anesthesia.
 
-This doesn't work because the anesthesia is the main component of the code -- either you-re doing it under general anesthesia or you-re not really performing the procedure,- says Barbara J. Cobuzzi, CPC, CPC-H, CPC-P, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

Option 3: Fold Removal Into an E/M

If the original surgeon removes the sutures after the initial procedure's global period, you may consider the removal when deciding on an appropriate E/M service level. You may also use this option if the doctor removing the sutures is not the original operating physician.
 
Example: A Medicare patient gets a large cut on his hand while on an out-of-state vacation and must visit the local emergency department for stitches. The ED doctor reports 12044 (Layer of closure of wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm), but the patient returns to his home state the next day and can't have the sutures removed by the same physician.
 
-Removal of sutures by other than the operating surgeon may be coded as a level of E/M service if the suture removal is the only postoperative service performed,- according to the spring 1992 issue of the AMA's CPT Assistant.
 
The approach: -The patient's primary-care physician should report a low-level E/M, such as 99212, for removing the sutures,- Templeton says. This office visit would most likely not warrant a higher E/M because the  history, exam and medical decision-making are minimal for suture removals. However, documentation reporting the suture removal and supporting the proper level of E/M service should accompany the claim, Templeton says.
 
Another way: In complex cases, such as multiple lacerations, you may be able to reflect your suture removal in a prolonged service E/M, such as 99212 and 99354, says Eric Sandhusen, director of reimbursement, HIPAA and fiscal compliance for the Columbia University department of surgery in New York. But this procedure must add on at least another 40 minutes to the E/M.

Option 4: Call on 46754

You may be able to use 46754 (Removal of Thiersch wire or suture, anal canal) in limited, anatomically specific cases (specifically, when the surgeon must remove sutures from the anal canal).

Example: A patient has undergone a hemorrhoid procedure or a fistula repair and must have a Thiersch wire removed from his anal canal. In this case, you would report 46754.

Fact: Other than 15850 and 15851, this code is the only other code in which CPT will let you report a suture removal under a procedural code by itself.