Those who work in the healthcare industry are often accustomed to medical terminology and the alphabet soup of acronyms. However, even those with the most extensive experience with medical jargon occasionally find themselves stumped by Current Procedural Terminology (CPT) codes.
In the United States, we rely on the CPT coding system to report our services and request reimbursement from payers. Therefore, staying on top of any CPT code changes that may have occurred in your specialty is important. For example, if you’re a wound care provider, it helps to know about active wound care management codes, debridement codes, and even suture removal CPT codes. Suture removal codes should be used alongside an appropriate code for the primary service to ensure accurate billing.
The CPT codes for suture removal are rarely addressed, despite being a common practice. Since we know this is important for you in your day-to-day practice, we’ll do a deep dive on the topic to bring you up to speed. With the CPT codes set being an integral component of the healthcare industry’s transition toward value-based care, you definitely don’t want to skip this.
The History of the CPT Code Set
Before we review the CPT for suture removal codes, let’s clarify the CPT code set as a whole.
CPT stands for Current Procedural Terminology, which was established to help health professionals identify and report the procedures and services they provide in a way that other stakeholders can understand.
It is also important to include an appropriate E/M code when reporting CPT codes for suture removal to ensure accurate documentation and proper billing and reimbursement for the procedure.
CPT System History
CPT system was created and published by the American Medical Association (AMA) in 1966. The first edition mainly included codes for surgical procedures. In 1970, the system expanded to include diagnostic and therapeutic procedures in surgery, medicine, and the specialties. At that time, the five-digit numeric coding system was also introduced, which is what we’re familiar with today.
In 1983, the Centers for Medicare & Medicaid Services (CMS) and Healthcare Common Procedure Coding System (HCPCS) adopted the CPT system. That same year, CMS required that CPT codes be used to report services for Part B of the Medicare program. A few years later, in 1986, state Medicaid agencies were mandated to use CPT codes, too.
In 2000, the Department of Health and Human Services selected the CPT code set as the national coding standard for physicians and other healthcare professional services and procedures under the Health Insurance Portability and Accountability Act (HIPAA).
Today, CPT codes are used not only by federal programs but also by private insurers. They’re used for administrative purposes, like claims processing and producing guidelines for medical care review. CPT codes are also helpful in research by making it easier for researchers to identify and categorize medical services and procedures.
In short, they’ve become the language of medicine, and we now rely on them in numerous ways.
ehr
A wound care EHR for better patient outcomes
CPT Codes and Value-Based Care
CPT codes will become even more important as we transition from fee-for-service to value-based care. In one blog post on the AMA website, the chair of the AMA expressed that “value-based care relies on a consistent nomenclature,” which is what these codes offer. With payment amounts tied to quality, healthcare outcomes, cost of care, and more, current procedural terminology codes are needed to assess what the value is.
Including an appropriate E/M code when reporting CPT codes for suture removal is essential for evaluating the patient’s wound, ensuring accurate documentation, and facilitating proper billing and reimbursement for the procedure.
CPT Codes and the Financial Viability of Your Practice
While essential, we can’t overlook the fact that billing and coding can also be problematic. For instance, some providers fail to include relevant documentation details, which results in their organization billing for an inferior level of health service compared to the care provided. This is known as down-coding.
Many providers struggle to document thoroughly because of time constraints or simply being overly cautious. Yet, when this occurs, it misrepresents the services rendered and leads to revenue loss. One study mentioned, “An institution can markedly improve revenues by ensuring that coding notes accurately reflect the complexity of care delivered.”
In a nutshell, the CPT codes you use or don’t use can financially affect your business. But how do you capture the right codes without increasing your staff’s workload? After all, doesn’t that mean your providers will need to spend more time documenting? Or will your medical billing and coding team have to dedicate additional time to reviewing documentation and researching industry trends? Luckily, not exactly.
A wound care-specific EHR can help practices maximize reimbursements, reduce claim denials, and create defensible documentation in less time. That way, your practice doesn’t overlook something like a suture removal CPT code. Suture removal codes should be used alongside an appropriate code for the primary service to ensure accurate billing.
CPT Codes and ICD-10 Codes: Are They the Same?
It’s no secret that the healthcare industry has many codes, and two that commonly get mixed up are CPT and ICD codes. ICD refers to the International Classification of Diseases, which was created by the World Health Organization (WHO) and ten international centers. It’s utilized worldwide to identify a medical diagnosis or condition while also establishing why a patient is getting treatment. CPT codes, on the other hand, document the treatment rendered or explain what services are being delivered.
While they’re different, the codes work together to tell a patient’s story. The treatments provided to the patient, as explained by the CPT codes, must align with the diagnosis established by the ICD code.
Suture Removal CPT Codes: What You Should Know
Now that we’ve covered the CPT coding system, let’s get into the nitty gritty of coding for suture removal. When the 2023 code set was published, it revealed two new codes for suture or staple removal and one revised code. It is important to use the correct codes specifically for suture and staple removal procedures, particularly when performed alongside Evaluation and Management visits. Let’s start with the revised code.
A Revised Suture Removal CPT Code
Prior to 2023, two suture removal CPT codes, 15850 and 15851, differentiated whether a provider was removing sutures or staples put in by the same physician or another physician. However, in 2023, that differentiation was removed and instead the type of anesthesia was added, which resulted in the deletion of the CPT code 15850.
Effective January 2023, CPT code 15851 is used to report the removal of sutures or staples requiring anesthesia regardless of whether the healthcare provider removing them also performed the primary procedure. The CPT code also describes the required anesthesia as being “general anesthesia” or “moderate sedation.” Therefore, this code isn’t applicable to situations where local anesthesia is used.
Coders should be aware that suture removal procedural code 15851 reflects a slightly more complex removal process that cannot be safely or comfortably performed without utilizing anesthesia. It is also important to include an appropriate E/M code when reporting codes for suture removal to ensure accurate documentation and billing.
New Add-On Codes for Suture Removal
The two new CPT codes for suture removal are 15853 and 15854.
The code for the removal of sutures or staples that don’t require anesthesia is 15853. However, if a service includes the removal of both sutures and staples without anesthesia, the code 15854 should be used.
Anytime you report these codes, you must include an appropriate and medically necessary evaluation and management (E/M) code for managing the patient’s wound. As add-on codes, 15853 and 15854 don’t require a modifier, but they should never be billed by themselves.
Some examples of E/M codes your practice could use include:
- 99202
- 99203
- 99204
- 99205
- 99211
- 99212
- 99213
- 99214
- 99215
- 99281
- 99282
- 99283
- 99284
- 99285
- 99341
- 99342
- 99344
- 99345
- 99347
- 99348
- 99349
- 99350
In addition, there are common procedures that may involve sutures and/or staples and have a zero-day global period, such as:
- 28001: A provider drains fluid from an infected bursa of the foot
- 28002: A provider creates an incision in a bursa to drain infected material that may involve the covering of the tendon
- 28003: A provider drains fluid from multiple infected bursal spaces underneath the fascia of the foot
- 28820: A provider amputates the toe at the metatarsophalangeal joint
- 28825: A provider amputates the toe at an interphalangeal joint
FYI about Add-On Codes for Suture Removal
It’s important to note that when using these codes, the suture removal service must have a zero-day global period. A zero-day global period means there is no preoperative period and no postoperative days. It solely includes the day that the procedure is performed. If suture removal takes place during a global period, then the code for suture removal is already included in the main procedure code.
Suture removal codes should be used alongside an appropriate code for the primary service to ensure accurate billing and adherence to coding guidelines.
Also, according to the CMS Federal Register, the Relative Value Scale Update Committee (RUC) values these codes as practice expense only codes (i.e., non-physician staff time, equipment use, supplies). Therefore, they don’t have physician work RVUs assigned to them.
Why Are the Add-on Codes Needed?
So, why are these codes important? In the past, providers would remove sutures and staples placed by other providers, and there wasn’t a code for reporting these services separately from the E/M follow-up visits. An example might be if a patient presented to the emergency department and received a laceration repair but went to their primary care office for suture or staple removal. Now, with these new codes, they may be reimbursed for these services.
However, keep in mind that these codes are not applicable to situations where one provider in a group of the same specialty applied the sutures or staples, and then another provider within the group removed them. In that example, the removal fee is already included in the initial service fee. It is also essential to include an appropriate E/M code when reporting CPT codes for suture removal to ensure accurate documentation and billing.
A Quick Review of the Suture Removal CPT Codes
We know that was a lot of information above, so here’s a quick review of those codes.
- 15851: The provider removes the sutures or staples under anesthesia
- 15853: The provider removes the sutures or staples and did not require anesthesia
- 15854: The provider removes the sutures and staples and did not require anesthesia
It is important to use the correct CPT codes specifically for suture and staple removal procedures, particularly when performed alongside Evaluation and Management visits.
Suture Removal CPT Codes Reimbursement Amounts
At this point, if you’ve wondered, “Can I get paid for suture and/or staple removal?” you’ve probably figured out the answer is yes. Yet, you might now ask, “Well, how much might I be paid for using a CPT for suture removal code?”
In 2024, the average Medicare reimbursement for 15851 was $56.59. For that same year, the reimbursement for 15853 and 15854 was $11.65 and $15.98, respectively. Some organizations may question if it’s even worth it, reimbursement-wise, but in our opinion, it’s crucial to capture everything that’s rightfully due to your practice. Using an EHR can help streamline this process. Suture removal codes should be used alongside an appropriate code for the primary service to ensure accurate billing.
When Should Sutures Be Removed?
Non-absorbable sutures are used to close external wounds or skin and repair blood vessels, aiding wound healing. The amount of time sutures stay in place varies, depending on factors like the patient’s medical history, wound severity, and the location of the wound. However, they usually stay in for five to 14 days. The importance of using correct procedural codes, specifically for suture and staple removal procedures, particularly when performed alongside Evaluation and Management visits, cannot be overstated.
Here’s a general idea of suture and staple removal time based on where they’re placed on the body.
- Face: five days
- Scalp: seven to 10 days
- Chest, legs, and back: seven days
- Arms and legs: 10 to 14 days
- Digits, palms, and soles: 10 to 14 days
In addition, there are times when providers may have a patient come in sooner than those suggested timeframes. For instance, if they experience severe pain in the wound, the suture came out early, the wound appears infected, or they have a fever, they should visit a medical professional right away.
The Success of Your Practice Includes Proper CPT Coding
Imagine how much money you might be leaving on the table by not capturing certain CPT codes. CPT codes for suture removal might seem like something to brush off when other tasks already bog down your staff, However, there’s a way to capture suture removal codes and others like them without overwhelming you or your team.
Leveraging your wound documentation can keep your organization ahead of the game. By accessing advanced and efficient coding techniques, you’ll likely experience maximized reimbursements and decreased claim denials while ensuring compliance for better financial outcomes. Including an appropriate E/M code when reporting CPT codes for suture removal is essential for evaluating the patient’s wound, ensuring accurate documentation, and facilitating proper billing and reimbursement for the procedure.