Internal Medicine Coding Alert

Question: One of our physicians wants to charge separately for suture removal without anesthesia. We feel we cant do that. Can you supply documentation supporting either way?

Laurie Moll
Sun Valley Internists, Sun City, Ariz.

Answer: Suture removal without anesthesia, when performed by the same physician who performed the surgery or wound repair, is considered by HCFA to be part of the global surgical package. Major surgery usually has a global surgical package of 90 days and minor surgery (a starred procedure) has a global surgical package of 1-10 days depending on the procedure. To code separately for removal of sutures without anesthesia is considered by HCFA to be unbundling the entire service rendered.

Since HCFA considers removal of sutures without anesthesia part of the global surgical package, CPT 2000 does not contain a code for that procedure. If sutures are applied by a physician, either after surgery or for wound repair, and another physician removes them without anesthesia during the global surgical package, the second physician would include the removal of sutures in his overall E/M level of care and assign an appropriate E/M code.

CPT has two codes for removal of sutures under anesthesia. Code 15850 (removal of sutures under anesthesia [other than local], same surgeon) and 15851 (removal of sutures under anesthesia [other than local], other surgeon). Since both of these procedures require a return trip to the operating room, if they were performed during the global surgical period, they would be billed with modifier -78 (return to the operating room for a related procedure during the postoperative period).