Suture CPT question
When reporting for suture removal, you have the option of reporting the same code that described the initial procedure and appending modifier 55 Postoperative management only. Postoperative care usually accounts for approximately 10 percent of the procedure’s value.
Returning to our example above, suppose an emergency department (ED) physician performed the wound repair (12052), but the patient’s primary care physician (PCP) removed the sutures at a later date. In an ideal world, the PCP would report 12052-55 for postoperative care (including suture removal).
An alternative tactic is to report a low-level evaluation and management (E/M) service for a problem-focused visit, especially when suture removal occurs outside of the global period. As always, documentation must support medical necessity for the visit.
Sutures are removed under anesthesia.
This circumstance is rare, but when documented and supported by medical necessity, you may report 15850 Removal of sutures under anesthesia (other than local), same surgeon or 15851 Removal of sutures under anesthesia (other than local), other surgeon, depending on whether the same surgeon who performed the initial procedure, or a different surgeon, removed the sutures.
Payer accepts S codes.
Some private payers (but not Medicare) may accept S0630 Removal of sutures by a physician other than the physician who originally closed the wound for suture removal, as long as the physician who removes the sutures isn’t the physician who placed them.
In any case, when suture removal is the primary reason for the patient encounter, report V58.3 Encounter for other and unspecified procedures and aftercare; attention to surgical dressings and sutures as the first-listed diagnosis.