Neurosurgery Coding Alert

Question: What CPT and ICD-9 codes should I use when suture removal is done in the neurosurgeons office?

Connecticut Subscriber

Answer: You can bill for the suture removal using an E/M code, only if the sutures were placed for a laceration repair that was a starred procedure (or had no global period, for Medicare) and you performed the repair and placed the sutures. If sutures are removed from an operative wound or if the laceration repair is not a starred procedure, and you placed the sutures, the service would be considered part of the global period. However, if another physician placed the sutures regardless of whether the procedure is starred you can bill for this using an E/M code (document the location of the original suturing, and the name of the physician who performed it).

Starred procedure indicates a minor surgical service, equivalent to a Medicare service with no global period. Many laceration codes are starred procedures, including 12001*-12004*, 12011*, 12013*, 12031*, 12032*, 12041* and 12051*. The neurosurgeon who performs the removal for these procedures should bill using an E/M services code.

Diagnosis code V58.3 (attention to surgical dressings and sutures) could be used, although you would probably be checking how the patient is recovering from the injury in general. Some payers refuse to recognize all V codes, but many will accept V58.3.