General Surgery Coding Alert

Look for new and revised codes.

General surgeons have several new and revised integumentary codes at their disposal in 2023 to report common services for managing skin defects.

Read on to learn about code changes that impact how you might report mesh implantation or removal of sutures and staples.

Differentiate Updated Suture/Staple Removal Codes

CPT^® 2023 deletes the single existing code for removing sutures under anesthesia when your surgeon initially placed the sutures. The deleted code is 15850 (Removal of sutures under anesthesia (other than local), same surgeon).

In place of that single code, CPT^® 2023 revises one code and adds two new codes, as follows (strike through indicates deleted words, underline indicates added words):

• Revised code 15851 (Removal of sutures or staples under requiring anesthesia (ie, general anesthesia, moderate sedation)(other than local), other surgeon)
• New code +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code))
• New code +15854 (Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code))

“Notice that these three codes no longer distinguish whether the removal is performed by the physician who performed the closure or another physician,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia.

Instead, the primary distinction between the codes is whether the procedure requires general anesthesia/moderate sedation (15851) or not (+15853 and +15854). “The codes also now indicate that you can use them for removal of staples, as well as sutures,” Joy says.

And/or: The distinction between +15853 and +15854 is whether the physician removes either sutures or staples (+15853) or both (+15854)

Add on: The two new codes for non-anesthesia removal procedures are add-on codes. That means you should list the code in addition to the E/M code for the service during which the physician performs the removal procedure. Revised code 15851 is not an add-on code, which means you may report it as a stand-alone procedure unrelated to an E/M service.

Know Restrictions for When and How to Report Removal Codes

Just because these new and revised codes exist doesn’t mean you can use them every time your surgeon removes sutures or staples.

“[Many] surgeries that require sutures or staples have a 90-day global period, and the removal is part of the surgical [package],” says Melanie Scott, CPC, CRHC, CPPM, CMPE, director of operations at Five Valleys Urology in Missoula, Montana.

Opportunity: Your surgeon might turn to these codes when removing sutures or staples from a procedure performed by a different physician regardless of the global period of the initial procedure.

Standalone: You shouldn’t use 15851 when the surgeon removes sutures/staples as part of another procedure. A new CPT^® note following 15851 states, “Do not report 15851 for suture and/or staple removal to re-open a wound prior to performing another procedure through the same incision.”

Greet New Code for Mesh Implantation

CPT^® 2023 introduces code 15778 (Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma).

Code 15778 isn’t the only CPT^® code for mesh implantation, so you’ll need to make sure you don’t use the code when a different, more specific code describes the surgical situation that involves mesh implantation. CPT^® 2023 adds notes with this code to direct you to those more-specific code options:

• For repair of anorectal fistula with plug [eg, porcine small intestine submucosa {SIS}], use 46707.
• For implantation of mesh or other prosthesis for anterior abdominal hernia repair or parastomal hernia repair, see 49591, 49622.
• For insertion of mesh or other prosthesis for repair of pelvic floor defect, use 57267.
• For implantation of non-biologic or synthetic implant for fascial reinforcement of the abdominal wall, use 0437T.

“Reserve 15778 specifically for delayed closure of an abdominal, genital, or perineal defect due to infection or trauma,” Brame says.

Delayed closure indicates that the wound has been left open for a period of time to allow for work such as cleaning, debridement, and monitoring infection. The general surgeon may perform the mesh implantation following work by another physician, such as a urologist treating a condition such as Fournier’s gangrene of the genitals, according to Scott.