Report suture removal with CPT 15850 for the same surgeon, CPT 15851 for another provider, or HCPCS S0630 if another provider removed the sutures during a follow-up visit.
Be aware that the removal of sutures is part of a minor surgical procedures’ global package according to CMS, Medicare, and CPT.
1. What Is CPT Code 15850?
CPT 15850 can be used for the removal of sutures if a surgeon places a suture during a procedure and removes it as well.
This code can only be billed if the patient is under general anesthesia because the suture removal is too painful or the patient cannot cooperate.
The CPT book describes CPT code 15850 for suture removal as: “Removal of sutures under anesthesia (other than local), same surgeon.”
The 15850 CPT code starts with anesthetizing the patient. The patient needs to be under general anesthesia before the surgeon can start the procedure.
The surgeon previously placed the sutures during the prior surgical procedure. The same surgeon also removes them and completes the procedure.
1.3 Billing Guidelines
CPT code 15850 can only be billed if the patient is under general anesthesia and this is medically necessary and appropriate. Make sure to provide the payer with enough documentation to prove that general anesthesia was necessary to remove the sutures.
Do not report CPT 15850 if the surgeon who removes the sutures differs from the surgeon who performed the prior surgical procedure. Instead, use CPT code 15851.
2. What Is CPT Code 15851?
CPT 15851 covers another sutures removal procedure. You can use this code if the suture removal is performed by a different provider than the surgeon who placed the sutures.
CPT code 15851 can only be billed if the sutures are removed while the patient is under general anesthesia because the procedure is too painful, which is the only way to make the patient cooperate.
The CPT book defines the 15851 CPT code for sutures removal as: “Removal of sutures under anesthesia (other than local), other surgeon.”
The CPT code 15851 procedure starts when the patient is placed under general anesthesia. Sutures were placed during a prior surgical procedure.
Then, a different surgeon performed the sutures removal procedure. This needs to be another surgeon than the one who placed the sutures during the primary surgery.
2.3 Billing Guidelines
Do not report CPT 15851 if the sutures were removed by the same surgeon as the one who placed them. You can report CPT code 15850 instead.
Payer will require documentation to prove that the patient was under anesthesia (other than local). The claim will be denied if anesthesia was not medically necessary.
3. What Is HCPCS Code S0630?
HCPCS S0630 covers a follow-up service in which a provider removes sutures from the patient’s wound.
HCPCS defined S0630 as follows: “Removal of sutures; by a physician other than the physician who originally closed the wound.”
The HCPCS S0630 procedure can only be performed if a physician closes a wound during an emergency visit or, for example, during surgery.
Then, the patient visits another physician for the removal of the sutures because the patient is not in the original locality.
3.3 Billing Guidelines
Be aware that HCPCS S0630 is not payable by Medicare.
S0630 can only be billed if the follow-up services are performed by a provider other than the surgeon who provided the initial procedure.
If applicable, you may report HCPCS code S0630 with another E/M service.
The provider who performs the S0630 procedure cannot be off the same practice as the surgeon who sutures the patient.