Podiatry Coding & Billing Alert

Formula: Removal with anesthesia = 15850 or 15851

The bad news: suture removal is usually bundled into the global, so forget about earning that extra revenue by billing it separately. The good news: you can take advantage of basic coding options available that will improve documentation and save you out of compromising situations.

Learn the tricks of the trade by resolving these 3 myths.

Myth 1: 99024 Is a "Trophy" Code

Reality: You think that just because 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) has zero charge, it has no better function. But the truth is, you can use it as a valid code for indicating suture removal.

Example: A patient underwent a laceration repair eight days ago for a 5-cm cut on her foot. You would use 12042 (Layer closure of wounds of neck, hands, feet, and/or external genitalia]; 2.6 cm to 7.5 cm) to report it. Laceration repair codes (12001-13153) already include, which has a 10-day global period, already include suture removal.

CPT 99024 has one other important function: You can use it to keep track of visits for risk management purposes to show that the patient presented for a follow-up visit within the surgical period, says Linda S. Templeton, CPC, CPC-H, an independent coding consultant in Fenton, Mich.

Myth 2: You Can Report Modifier 52 on 15850 or 15851

Reality: Not so fast. One of the common mistakes that people commit in using 15850 (Removal of sutures under anesthesia [other than local], same surgeon) and 15851 (Removal of sutures under anesthesia [other than local], other surgeon), is appending a modifier 52 (Reduced services) to report a nonanesthesia suture removal. Anesthesia is the main component of 15850 and 15851. If there is no anesthesia given then what good are these codes?

Although some practices would address this situation by bundling the suture removal into the E/M service, Beresh challenges it, specifically if done outside the global period. "If suture removal is the main component of the visit it will not qualify for an E/M visit. Also, if the physician is in your group, I disagree about charging an E/M visit," he maintains.

Helpful: You have the option to report 15850 or 15851 for patients who go under general anesthesia specifically for suture removal. For example, the physician performs a suture removal with anesthesia for a patient whose sutures are buried deep in the skin tissues of the wound edges. He does the procedure post-traumatic laceration by another doctor out of town. On the claim, you would report 15851.

Myth 3: E/M Has Nothing To Do With Suture Removal

Reality: When your physician removes the sutures during an office visit that were originally placed by a different physician, you should submit a low-level E/M code, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient).

Example: The podiatrist reports 28062 (Fasciectomy, plantar fascia; radical [separate procedure]), but the patient is returning to her home state before the podiatrist can remove the sutures, so the patient makes an appointment with a home town physician for suture removal. Under this situation, you would use 99212 for the procedure.

Source: "There is not a separate code that describes removal of sutures when the removal is not performed under anesthesia. If the physician who removed the sutures did not place the sutures, then the suture removal would be considered part of evaluation and management (E/M)," according to CPT Assistant Q&A.

Another way: When a patient has a private carrier, for example Blue Cross Blue Shield, you may be able to report suture removal with S0630 (Removal of sutures by a physician other than the physician who originally closed the wound) as an option. Just make sure the carrier recognizes the code, and a different physician than the one who placed the sutures removes them.

Warning: Double check with your insurer before submitting S0630. If the carrier doesn't carry it, stick with an E/M code.