Practice Management Alert

Question: Is there a code for removal of staples by someone other than the surgeon, or is it bundled into the office visit?
    
Michigan Subscriber  Answer: In most cases, removal of staples is covered under the global fee for surgery. You cant charge extra for staple removal any more than you could charge for putting them in, says Tray Dunaway, MD, FACS, with Healthcare Value Inc. in Camden, SC. Its all included in the surgical charge.
 
Thats usually the case regardless of who is removing the staples. For example, if the surgeon removing the staples is a partner of the operating surgeon, the partners must bill as though they are the same physician and the removal wouldnt be separately billable, adds Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coordinator of the Health Information Management Program at Clarkson College in Omaha, NE. Further, if the patient has moved or if for some other reason another physician is providing the post-op care, removal of staples will be bundled into that post-op service, she continues.
 
All this applies to normal, uncomplicated removal of staples, Bucknam notes. Things get more interesting if the removal is complicated in some way, and then in some cases you can bill separately for staple removal.
 
For example, 15851 can be used if the removal is done under anesthetic, but not if the staples are removed without anesthesia, Bucknam says. Also, if the staples are infected or otherwise need to be removed out of the global period, you can bill for removal of foreign body codes for the applicable body part, she continues. Finally, if the staples are on infected skin, it might be more appropriate to code a debridement code, which would include the removal of staples and the debridement of the infected skin, she concludes.