A guide to the new codes for suture/staple removal
Suture and staple removal is a common procedure in family medicine and there are new CPT codes for it this year that cover related practice expenses and supplies:
+15853 Removal of sutures or staples not requiring anesthesia
(List separately in addition to E/M code)
+15854 Removal of sutures and staples not requiring anesthesia
(List separately in addition to E/M code)
Family physicians often remove sutures or staples placed by other providers, and CPT previously did not provide codes for reporting these services separately from the E/M follow-up visit. These new codes allow for that. Note that if the sutures or staples were placed in your office, the fee for the removal is usually included in the fee for the initial procedure. Typical office-based procedures have a 10-day “global period” (but some, such as skin punch biopsies, 11104, have a zero-day global period). Visits for suture/staple removal within the global period would not be billed separately. But if the visit occurs outside of the global period, which could happen in a number of scenarios, submit the E/M code and the suture/staple removal code. The Centers for Medicare & Medicaid Services’ website allows you to search for global periods for specific procedure codes.
When you report either 15853 or 15854, include an appropriate E/M code for evaluating the patient’s wound. Because these are add-on codes, no modifier is necessary. But like other add-on codes, they should never be reported without a code for the primary service (i.e., don’t report 15853 or 15854 when no E/M service is provided).
The average Medicare reimbursement for 15853 and 15854 is $11.52 and $16.27, respectively.
While not as common in family medicine settings, when suture or staple removal requires either moderate sedation (e.g., in a young child) or general anesthesia, report code 15851 instead of 15853 or 15854.
— Samuel L. Church, MD, MPH, CPC, CRC, FAAFP
Northeast Georgia Medical Center Family Medicine Residency, Core Faculty
AMA CPT Editorial Panel member
Posted on April 13, 2023