General Surgery Coding Alert

Question: A child is returned to the operating room for suture removal under anesthesia. The child earlier had surgery for cleft lip repair. Should 15850 (Removal of sutures under anesthesia [other than local], same surgeon) be appended with modifier -23 (Unusual anesthesia) or modifier -78 (Return to the operating room for a related procedure during the postoperative period) when coding this procedure?

Florida Subscriber

Answer: Neither. The correct modifier is -58 (Staged or related procedure or service by the same physician during the postoperative period) because the second procedure (the suture removal) was planned in advance and in stages. Step 1 was putting the sutures in; step 2 is removing them.

Modifier -23 is rarely used or paid and is inappropriate in this case because anesthesia is included in 15850, which is used to report mainly pediatric procedures because children are far more likely to require anesthesia for suture removal.

Modifier -78 does not apply because the removal of sutures is not a complication.

The correct diagnosis code for this service is V58.3 (Attention to surgical dressings and sutures). Obtaining payment for 15850 is difficult. According to Medicare, it is a bundled code (with status B assignation in the physician fee schedule) and therefore is never payable.