Billing for suture removal in the United States is complex due to procedural coding rules. Generally, payment for suture removal is bundled into the initial surgical fee, meaning it is not a separately billable service. However, specific exceptions exist based on the timing, circumstances, and the provider performing the service, which can allow for a separate charge to be submitted.
The Global Surgical Package Rule
Suture removal is typically not a standalone billable service due to the Global Surgical Package, a payment policy established by payers like Medicare. This package pays the surgeon a single, comprehensive fee that covers all routine services provided before, during, and for a set period after a surgical procedure. The purpose of this global period is to simplify billing and prevent fragmentation of payment for typical follow-up care.
The duration of this global period varies based on surgical complexity, ranging from 0 days for minor procedures to 90 days for major surgeries. Routine post-operative care, including wound checks, staple removal, and suture removal, is explicitly included in this single payment if it occurs within the designated timeframe. Since the surgeon has already been compensated for this standard follow-up care within the initial surgical fee, no additional charge can be submitted for suture removal during this period.
Conditions That Allow Separate Billing
While the global package is the standard, specific scenarios allow suture removal to be billed separately.
Removal by a Different Provider
One common exception occurs when the removal is performed by a healthcare provider who was not associated with the initial surgery. For example, if a patient receives laceration repair from an emergency room physician while traveling, their primary care physician can bill for the removal upon the patient’s return home.
Global Period Expiration
Separate billing is possible if the removal occurs after the surgical global period has officially expired. If a procedure has a 10-day global period, and the patient returns on day 12 because the wound required extra time to heal, the service may be billable. Documentation must support the medical necessity for the delayed visit; billing is not permitted if the delay is purely for scheduling convenience.
Unrelated Injury
A third circumstance involves the removal of sutures from a wound that is completely unrelated to a recent surgical procedure still within its global period. For instance, a patient recovering from an appendectomy might sustain a separate laceration requiring stitches. Because the laceration and its closure are distinct from the abdominal surgery, the removal of those specific sutures can be billed during the post-operative period.
Coding and Documentation Requirements
When separate billing is justified based on one of the exceptions, the service is generally coded using an Evaluation and Management (E/M) code to reflect the office visit. These codes, such as 99202–99215, are selected based on the complexity of the visit, which includes a wound assessment and the medical decision-making involved. The E/M code is the primary billable service, and the suture removal is considered part of the service provided during that visit.
For suture removal not requiring anesthesia, specific add-on CPT codes, such as +15853 or +15854, capture the practice expense associated with the procedure. These codes must be reported in conjunction with the appropriate E/M code and are never billed alone, but they help cover the cost of supplies and staff time. If the removal is performed by the same surgeon during the global period but is for an unrelated injury, a modifier such as 24 may be required on the E/M code to signal that the service is unconnected to the global procedure.
Detailed documentation is necessary to support the claim and prevent payer denial. The medical record must clearly justify the reason for the separate bill, linking it directly to the exception outside the global package rules. This includes specifying that the initial procedure was performed by a different provider, that the global period has expired, or that the wound treated is unrelated to ongoing post-operative care.