Podiatry Coding & Billing Alert

New codes make it easier to code these services, but watch out for bundles.

Reporting suture removal has always been a bit of a headache for podiatry coders. Many payers don’t want to reimburse this service, and in the past, CPT^® only included codes for removing stitches when you had to put the patient under anesthesia.

That’s why some coders considered CPT^® 2023 as a gift, with the debut of several new suture removal codes that document the service when it does not require the need for anesthesia. However, even though these codes give you more options for taking out stitches and staples, they won’t completely halt your coding woes.

Read on to find out what the new codes describe and how you should use them.

Tip 1: Say Goodbye to 15850

As you might know, CPT^® 2023 deleted a longtime code, 15850 (Removal of sutures under anesthesia (other than local), same surgeon), which described removing sutures under anesthesia. Prior to 2023, you would apply this code when your podiatrist was the physician who initially placed the sutures.

In place of that single code, CPT^® 2023 revised one code and added two new codes, as follows (a strikethrough indicates deleted words, underline indicates added words):

• Revised code 15851 (Removal of sutures or staples under requiring anesthesia (ie, general anesthesia, moderate sedation)(other than local), other surgeon)
• New code +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code))
• New code +15854 (Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code))

Key difference: One big change from the past is that the 2023 codes “no longer distinguish whether the removal is performed by the physician who performed the closure or another physician,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager at MRO in Philadelphia.

Instead, the primary distinction between the codes is whether the procedure requires general anesthesia/moderate sedation (15851) or not (+15853 and +15854). “The codes also now indicate that you can use them for removal of staples, as well as sutures,” Joy says.

And/or: The distinction between +15853 and +15854 is whether the physician removes either sutures or staples (+15853) or both (+15854).

Add-on: The two new codes for non-anesthesia removal procedures are add-on codes. That means you should list the code in addition to the evaluation and management (E/M) code for the service during which the physician performs the removal procedure. Revised code 15851 is not an add-on code, which means you may report it as a standalone procedure unrelated to an evaluation and management (E/M) service.

Tip 2: Be Aware of Bundling Rules

Just because these new and revised codes exist doesn’t mean you can use them every time your podiatrist removes sutures or staples. “[Many] surgeries that require sutures or staples have a 90-day global period, and the removal is part of the surgical [package],” says Melanie Scott, CPC, CRHC, CPPM, CMPE, director of operations at Five Valleys Urology in Missoula, Montana. Therefore, you cannot report a suture removal that occurs within 90 days of the surgery when the podiatrist actually placed the staples or sutures.

However, your podiatrist might turn to these codes when removing sutures or staples that a different physician placed, regardless of the initial procedure’s global period.

Check This Example

To put it all together, consider this example of when you might report one of the new codes for suture removal:

A patient spends the winter in Florida, where a podiatrist there performs a plantar fasciectomy in early February. By mid-March, the patient returns home to New York, where a podiatrist in that state removes the sutures from the patient’s foot.

Even though the patient is still within the global period of the fasciectomy, the New York podiatrist can report an E/M code, such as an office/outpatient code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a/an new/established patient …), along with +15853.