How to code for suture removal
Suture Removal under normal circumstances should be included in the global surgical package.
Medicare established a national definition of a global surgical package to ensure that Medicare Administrative Contractors (MACs)) make payments for the same services consistently across all jurisdictions. This policy helps prevent Medicare payments for services that are more or less comprehensive than intended. In addition to the global policy, uniform payment policies and claims processing requirements have been established for other surgical issues, including bilateral and multiple surgeries, co-surgeons, and team surgeries. The information that follows describes the components of a global surgical package and billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.
The global surgical package, also called global surgery, includes all necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for the surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.
Both CPT(R) and the Centers for Medicare & Medicaid Services (CMS) consider suture removal to be part of a minor surgical procedure?s global package. If the same physician who placed the sutures removes them during the original procedure?s global period, one cannot report the removal separately. The removal becomes part of any E/M service reported, if a different physician removes the sutures.
Possible exceptions include:
1. If the patient must be placed under general anesthesia to remove the sutures, one 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. Circumstances under which generally anesthesia would be medically necessary or appropriate for suture removal are rare.
2. If the payer allows, report S0630 Removal of sutures by a physician other than the physician who originally closed the wound, as long as a different physician than the one who placed the sutures removes them. It is better to check with the insurer before submitting this code.