Pediatric Coding Alert

Hint:  Modifier 52 won't cure all of your coding woes

Your suture-removal services can be payable--but you have to know the rules before you bill.

Specific codes for suture removal are rare, and insurers often bundle it into the other services, so coding suture removal can make even the most seasoned pediatric coder groan. Learn the basic coding options and the stitching scenarios that apply to your suture-removal claims. Option 1: Honor the original procedure's global; use no separate code Scenario: Suppose a patient had a laceration repair eight days ago for a 3-cm cut on her scalp. The original procedural code, 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm), already includes the suture removal.

"Laceration repair codes (12001-13153) that would require a suture removal have a 10-day global period," says Linda S. Templeton, CPC, coding consultant for The Rybar Group Inc. in Fenton, Mich. So if the patient returns within that global period, you can't report the suture removal separately because it's already a part of the global service.

Other procedures that involve suture removal include major surgeries, which carry a 90-day global, Templeton says. "So for any other occasion, you wouldn't typically come across a scenario where you would consider reporting the suture removal separate from the primary procedure."

Tip: You can't report it to your payer, but CPT 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure) is valid for suture removal and is good for tracking.

Although it has zero reimbursement, you can use 99024 to keep track of visits for utilization purposes to show that the patient did present for a follow-up visit within the surgical period, Templeton says. Option 2: Report 15850 or 15851 Another common coding snag is when pediatric staff members try to report 15850-15851 for simple suture removals that don't involve anesthesia.

CPT reserves codes 15850 (Removal of sutures under anesthesia [other than local], same surgeon) and 15851 (Removal of sutures under anesthesia [other than local], other surgeon) for patients who go under general anesthesia for suture removal. General pediatricians rarely use these codes, but pediatricians who offer more surgical services may consider using them.

Example: The pediatrician used sutures to treat a patient's wound, but skin has grown over the sutures, requiring a complex suture removal.

If the pediatrician performs suture removal under general anesthesia, you can report a separate CPT code, such as 15850 or 15851.

Common mistake: Don't consider a modifier to stretch these codes to cover non-anesthesia suture removals. Some people will put [...]