Pediatric Coding Alert

Question: What CPT and ICD-9 codes should we use when suture removal is done in the pediatricians office?

Connecticut Subscriber

Answer: If the laceration repair is a starred procedure, and you perform the repair and place the sutures, you can bill for the suture removal using an evaluation and management (E/M) code. If the laceration repair is not a starred procedure, and you perform the repair and place the sutures yourself, you cannot bill for the suture removal. If another physician performs the laceration repair and places the sutures regardless of whether the procedure is starred or not you can bill for the suture removal using an E/M code (indicate on the claim form the location of the original suturing, and the name of the physician who performed it). Use modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M services code, as per CPT requirements for billing starred procedures.

Starred procedure indicates a minor surgical service. Many laceration CPT codes are starred procedures, including 12001*, 12002*, 12004*, 12011*, 12013*, 12031*, 12032*, 12041*, and 12051*. The pediatrician who performs suture removal for these procedures should bill using an E/M services code.

Although by CPT definition suture removal should be billable, any insurer using the relative value unit system will argue that suture removal is always bundled into the service of placing the suture.

Diagnosis code V58.3 (attention to surgical dressings and sutures) could be used for the suture removal, although you would probably be checking how the child is recovering from the injury in general.

Some payers refuse to recognize all V codes, but most accept V58.3. When dealing with an uncooperative payer, the open wound code (879.8) could be used first, followed by V58.3.


- Answers for Reader Questions and You Be the Coder provided by Susan Callaway, CPC, CCS-P, independent coding educator and consultant in Augusta, S.C.; Linda Walsh, senior health policy analyst, American Academy of Pediatrics; and Peter Rappo, MD, FAAP, Pediatric Associates, Brockton, Mass.