Removing sutures due to latent side effects

Q After having a total vaginal hysterectomy with anterioposterior (A&P) repair performed by another physician a year ago, a new patient presented to my practice with persistent spotting. I noted that a nonabsorbable suture was used in the vaginal cuff, and therefore resected the tail of the suture. I removed the protruding stitch that seemed to be causing the problem. Which codes should I use for the diagnosis and the procedure?

A Because the complication was the result of previous surgery, consider using 909.3 (late effect of complications of surgical and medical care) and 998.83 (other specified complications of procedures not elsewhere classified) to describe the suture that was causing the irritation. Or, if you think the problem with the suture was more closely related to disruption of the wound, use 998.3 as the second code instead of 998.83.

As for the suture removal, bill an E/M service because CPT only allows physicians to report suture removal as a surgical procedure when a regional block or general anesthesia is administered (15851, removal of sutures under anesthesia [other than local]), with another surgeon. (Note, however, that some payers only allow the use of this code with general anesthesia). If you replaced the suture after removing the original, bill 57200 (suture of vagina) in addition to the E/M service, and use the modifier -25 to indicate that the E/M service was significant and separate from the procedure.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q After having a total vaginal hysterectomy with anterioposterior (A&P) repair performed by another physician a year ago, a new patient presented to my practice with persistent spotting. I noted that a nonabsorbable suture was used in the vaginal cuff, and therefore resected the tail of the suture. I removed the protruding stitch that seemed to be causing the problem. Which codes should I use for the diagnosis and the procedure?

A Because the complication was the result of previous surgery, consider using 909.3 (late effect of complications of surgical and medical care) and 998.83 (other specified complications of procedures not elsewhere classified) to describe the suture that was causing the irritation. Or, if you think the problem with the suture was more closely related to disruption of the wound, use 998.3 as the second code instead of 998.83.

As for the suture removal, bill an E/M service because CPT only allows physicians to report suture removal as a surgical procedure when a regional block or general anesthesia is administered (15851, removal of sutures under anesthesia [other than local]), with another surgeon. (Note, however, that some payers only allow the use of this code with general anesthesia). If you replaced the suture after removing the original, bill 57200 (suture of vagina) in addition to the E/M service, and use the modifier -25 to indicate that the E/M service was significant and separate from the procedure.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q After having a total vaginal hysterectomy with anterioposterior (A&P) repair performed by another physician a year ago, a new patient presented to my practice with persistent spotting. I noted that a nonabsorbable suture was used in the vaginal cuff, and therefore resected the tail of the suture. I removed the protruding stitch that seemed to be causing the problem. Which codes should I use for the diagnosis and the procedure?

A Because the complication was the result of previous surgery, consider using 909.3 (late effect of complications of surgical and medical care) and 998.83 (other specified complications of procedures not elsewhere classified) to describe the suture that was causing the irritation. Or, if you think the problem with the suture was more closely related to disruption of the wound, use 998.3 as the second code instead of 998.83.

As for the suture removal, bill an E/M service because CPT only allows physicians to report suture removal as a surgical procedure when a regional block or general anesthesia is administered (15851, removal of sutures under anesthesia [other than local]), with another surgeon. (Note, however, that some payers only allow the use of this code with general anesthesia). If you replaced the suture after removing the original, bill 57200 (suture of vagina) in addition to the E/M service, and use the modifier -25 to indicate that the E/M service was significant and separate from the procedure.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.