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The CPT® Code 15854 refers to the procedure of removing sutures and staples from a patient without the need for anesthesia. This procedure is typically performed when the sutures or staples, which were previously placed during surgical or traumatic wound closures, have served their purpose and the wound has sufficiently healed. Unlike the removal of sutures or staples that requires anesthesia, which is covered under CPT® Code 15851, the removal under this code is considered a straightforward process that can be done without causing significant discomfort to the patient. The materials used for sutures and staples, such as synthetic, non-absorbable sutures made of prolene, nylon, or silk, are designed to hold the wound together during the healing process. Once the healing is complete, the removal of these materials is necessary to restore the skin's integrity and appearance. It is important to note that this code is reported separately in addition to an Evaluation and Management (E/M) code, indicating that the procedure is distinct from any other medical services provided during the same visit.
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The procedure associated with CPT® Code 15854 is indicated for the removal of sutures and staples that have been previously placed during surgical or traumatic wound closures. The following conditions may warrant this procedure:
The procedure for the removal of sutures and staples not requiring anesthesia involves several key steps, which are outlined below:
After the removal of sutures and staples, the healthcare provider may apply a topical antiseptic to the area to further reduce the risk of infection. Patients are typically advised to keep the area clean and dry for a specified period. They may also receive instructions on monitoring for any signs of infection, such as increased redness, swelling, or discharge. Follow-up appointments may be scheduled to assess the healing process and ensure that the wound is healing properly without complications.
| Short Descr | REMOVAL SUTR&STAPL XREQ ANES | Medium Descr | REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA | Long Descr | Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 99202 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | 99203 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99204 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99205 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99211 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | 99212 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | 99213 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99214 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99215 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99281 | Telehealth Service (Medicare) MPFS Status: Active Code APC J2 Physician Quality Reporting PUB 100 CPT Assistant Article Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | 99282 | Telehealth Service (Medicare) MPFS Status: Active Code APC J2 Physician Quality Reporting PUB 100 CPT Assistant Article Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | 99283 | Telehealth Service (Medicare) MPFS Status: Active Code APC J2 Physician Quality Reporting PUB 100 CPT Assistant Article Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | 99284 | Telehealth Service (Medicare) MPFS Status: Active Code APC J2 Physician Quality Reporting PUB 100 CPT Assistant Article Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | 99285 | Telehealth Service (Medicare) MPFS Status: Active Code APC J2 Physician Quality Reporting PUB 100 CPT Assistant Article Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | 99341 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | 99342 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99344 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99345 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. | 99347 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99348 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99349 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99350 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | G0463 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC J2 Hospital outpatient clinic visit for assessment and management of a patient |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 57 | Decision for surgery: an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | E2 | Lower left, eyelid | FA | Left hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | TA | Left foot, great toe | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2023-01-01 | Added | Code added. |
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