Pediatric Coding Alert

Question: My provider performed two button removals for undescended testes surgery. The provider performed surgery on both sides, and each side had a separate button. How would I code this, and would it require the repeat procedure modifier?

Oregon Subscriber

Answer: The code you’re looking for is +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code). It is an add-on code that should be used in conjunction with an evaluation and management (E/M) service, as specified in the parenthetical portion of the code descriptor.

You’ll report 15853 twice to account for both procedures, making sure to append laterality modifiers (RT and LT) to help specify the anatomical location of the procedure and indicate to the payer that you are reporting distinct services rather than reporting the same service twice.

Modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) would not be correct here though. It is used to indicate a repeated procedure or service by the same physician or other qualified health care professional, usually performed on the same day and subsequent to the original procedure or service. For the scenario you described, the removal of sutures or staples for the undescended testes surgeries are considered separate and distinct procedures rather than a repeat of an original procedure.

Therefore, coding will look like this:

• Appropriate E/M code
• 15853-RT (for the first button removal)
• 15853-LT (for the second button removal)

Some payers may still want modifier 59 (Distinct procedural service) on the second procedure to indicate that the second button removal is distinct and should be reimbursed separately. If that’s the case with this patient’s payer, your coding would therefore look like this for the second procedure: 15853-59-LT