Suture removal is a common procedure following wound closure, whether from a planned surgical operation or an urgent laceration repair. While the physical act of removing stitches is straightforward, the question of whether a healthcare provider can bill for this service is complex and depends heavily on the context of the original procedure. The default answer is usually no, as the cost for this follow-up care is generally bundled into the payment for the initial surgery. Understanding the specific rules that govern medical billing for surgical services is necessary to determine the rare scenarios where separate payment is allowed.
The Global Surgical Package
The primary reason suture removal is not typically billed separately is the application of the Global Surgical Package (GSP), a policy established by payers like Medicare to simplify billing. The GSP defines a single payment for a surgical procedure that covers all necessary and related services performed by the surgeon or a provider in the same group practice during a defined post-operative period. This package bundles the surgical operation itself with standard follow-up care.
Suture removal is considered routine post-operative care within this package. For minor surgical procedures, such as a skin biopsy or an intermediate laceration repair, the typical global period is ten days, starting the day after the surgery. Major surgical operations, like a hip replacement or a complex abdominal surgery, usually carry a 90-day global period.
If a patient returns to the operating surgeon or a colleague within the same specialty and group practice for suture removal during this defined 10-day or 90-day window, the service cannot generate a separate charge. The payment has already been made as part of the primary procedure’s reimbursement. This bundling rule ensures the provider is only paid once for the entire episode of care.
Conditions for Separate Billing
Separate billing for suture removal is only permissible when the circumstances fall outside the standard bundling rules of the Global Surgical Package. The most common scenario allowing a charge is when the removal is performed by a provider who was not involved in the original procedure. For instance, if a patient has surgery in one city and travels, an external provider, such as an urgent care clinic or a primary care physician, can bill for the service.
Another condition is when the procedure occurs after the global period has expired. A patient requiring stitches to remain in place longer than the standard 10 or 90 days due to slow healing can be billed for the removal visit once the global period has passed. However, for some procedures with a 10-day global period, the removal may still be considered inherent to the original service and not separately billable even after day ten.
A third condition involves sutures placed during non-surgical treatments or procedures with a zero-day global period. Simple laceration repairs for Medicare patients are one example where the follow-up visit and suture removal are not always bundled and can be billed. Procedures with a zero-day global period mean that any related service performed on a subsequent day is considered a distinct, billable encounter. Documentation must clearly specify that the removal meets the criteria for separate payment, such as noting the original surgeon’s name and practice if an outside provider is performing the service.
Coding When Suture Removal Is Billable
When the conditions for separate billing are met, the service is typically reported using a combination of codes. Since 2023, the Current Procedural Terminology (CPT) introduced specific add-on codes for the simple removal of sutures or staples that do not require anesthesia. Code 15853 is used for the removal of either sutures or staples, and code 15854 is reported if both are removed during the same encounter.
These add-on codes must always be reported in conjunction with an Evaluation and Management (E/M) code. The E/M code reflects the level of assessment and decision-making by the healthcare provider to ensure the wound is healing correctly. A minimal service visit, such as CPT 99211, might be used if the visit involves only a quick check and removal by a nurse or other clinical staff.
More complex visits, where the physician performs a problem-focused examination of the wound, would utilize codes such as CPT 99212 or 99213. The documentation must support the level of E/M service chosen, detailing the wound assessment and any medical decision-making involved. Since codes 15853 and 15854 are add-on codes, they do not require a separate modifier. Accurate coding and clear medical records are the final steps in justifying the claim for payment.