15853 suture removal code

[Feli]

These were codes new last year... I just found them today.
15853 removal another doc's sutures OR staples and 15854 " " sutures AND staples.
It seems 15853 (sutures or staples) is only about 0.3 NF RVU (so ~$15 for most payers).

Does anyone use this for pts with sutures from ER or urgent care or other docs?
What dx do you link them to?
What do you get for reimburse? (amount or plans paying or rejecting)

I had been using the S0630 code prior to this and basically since residency... no idea if it was getting paid on that or how much. It seems the new codes replace it?

I was adding this to my templates and figured I'd ask. Thanks for any exp or ideas.

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[Hybrocure]

I’m a noob. But I avoid doing any procedure codes if there’s a chance they’re going to reimburse less than or refuse standard billing for an encounter code. Routine care/injects aside. I don’t wanna risk chasing the extra couple bucks on top of an encounter code if it means insurance throws it all out and billing has to sort it out and it takes longer to get paid

I’ve thankfully yet to come across a situation in outpatient where I’m removing another docs sutures though. Honestly didn’t even know it was a code until now.

 

[AttackNME]

I’m a noob. But I avoid doing any procedure codes if there’s a chance they’re going to reimburse less than or refuse standard billing for an encounter code. Routine care/injects aside. I don’t wanna risk chasing the extra couple bucks on top of an encounter code if it means insurance throws it all out and billing has to sort it out and it takes longer to get paid

I’ve thankfully yet to come across a situation in outpatient where I’m removing another docs sutures though. Honestly didn’t even know it was a code until now.

Ya, I’m not gonna get rich removing sutures so I’m not gonna be using this code, better prioritize my biller’s time on negotiating insurance contracts

 

[HardRoadPaved]

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.

This is for going to urgent care and pcp offices prolly to recoop time/expense for suture removal if all patient saw was their nurse. As said before the e/m is better to use than trying this tack on code. Hard pass for me too.

A guide to the new codes for suture/staple removal

There are new CPT codes for suture and staple removal this year that cover related practice expenses and supplies. Here's what you need to know.

www.aafp.org

 

[Feli]

... I avoid doing any procedure codes if there’s a chance they’re going to reimburse less than or refuse standard billing for an encounter code....

... the e/m is better to use than trying this tack on code. ...

You guys are nicer than me. I bill basically everything I do.

I wouldn't skip a Jones wrap or a callus care or ultrasound or anything just because the payer might bounce it (or the E/M).

I have had the occasional bad payer (Hewmannah, MCA carriers, etc) where they start to pay the 99214 or the 11042 but not the other, but I still keep sending both if I do both.

 

[deleted1162946]

Off topic but not really, any suggestions for a graduating resident on how to learn how to bill properly?

 

[AttackNME]

Off topic but not really, any suggestions for a graduating resident on how to learn how to bill properly?

I liked Jeff Lehrman’s coding videos and webinars that I found online. Then read the online e/m pdf. That’s a start.

 

[Hybrocure]

When all else fails you can google cpts and spin the wheel on stuff people argued about on a forum 15 years ago

 

[Feli]

Off topic but not really, any suggestions for a graduating resident on how to learn how to bill properly?

I agree learning the E/M definitions is the main thing.
Modifiers are worth learning also. There are maybe 10 used real commonly in podaitry (kx, 25, 24, 59, 50, rt/lt, t#, q7/8/9, etc), then another 10 uncommon but useful (76, 77, 78, 79,etc).

I'd grab as many superbill sheets from your residency attendings' clinics as you can (icd and cpt codes). You will learn what procedures are commonly done in various offices, what dx codes are common. Obviously pick the ones who are worth emulating... not the TFPs.

You eventually want to make your own lists of favorite codes, common surgery codes. You should learn a ton from your biller if you can... some groups just use clearinghouses or off-site billers where that's tough. Worse, some have billers who don't know much about podiatry... or even about billing.

...The main mistake with billing are usually being afraid to bill and just doing E/M on everyone (not coding or undercoding procedures)...
or trying to bill a ton of codes on every visit (that'll PO the pts who get bills / read EOB, and most end up as bundling and getting rejected anyways... basically just wastes biller time).