Is Suture Removal Included in the Global Period?
Navigate the nuances of your medical bills. Learn when follow-up services are bundled with your main procedure and when they are billed independently.
Understanding what services are included in a medical procedure’s overall cost can be complex. The “global period” in healthcare billing refers to a defined timeframe around a surgical procedure. During this period, many related services are bundled into a single payment. A common question is whether routine suture removal falls under this bundled care or if it can be billed separately.
Understanding the Global Period
The global period represents a specific duration during which services related to a surgical procedure are included in the original fee. This bundling simplifies billing and prevents multiple charges for interconnected care. The timeframe typically includes pre-operative, intra-operative, and routine post-operative care.
Global periods commonly vary in length, designated as 0, 10, or 90 days. In practice, these often extend to 1, 11, or 92 days respectively to include the day of the procedure or the day before for major surgeries. For instance, a major surgical procedure usually has a 90-day global period, encompassing care from the day before surgery through 90 days after. Minor procedures might have a 0-day or 10-day global period.
Suture Removal as Part of Global Care
For most surgical procedures, routine suture removal by the operating physician or a covering physician is considered part of the bundled post-operative care within the global period. It is generally not billed as a separate service because it is a standard and expected component of the recovery process, directly related to the initial surgery.
Medicare and Current Procedural Terminology (CPT) guidelines generally consider routine suture removal to be part of the global package for a minor surgical procedure. If the same physician who placed the sutures removes them during the procedure’s global period, a separate charge is not typically allowed. This applies to services like bandage changes, local incision care, and routine removal of sutures or staples.
When Suture Removal May Be Billed Separately
Suture removal may be billed as a distinct service in specific circumstances, falling outside the typical global period. One scenario involves suture removal for a wound or procedure unrelated to the initial surgery. For example, if a patient is recovering from knee surgery but then presents to an emergency room for sutures from an unrelated laceration, the removal of those new sutures could be billed separately.
Suture removal performed after the global period of the initial surgery has concluded may also be billed separately. For instance, if a procedure has a 10-day global period and sutures are removed on day 15, an Evaluation and Management (E/M) code along with a suture removal code might be submitted. This is typically permissible only if the delayed removal is due to medical necessity, such as slow healing, rather than a scheduling convenience.
A separate charge may also be justified if the suture removal requires significant additional procedures due to complications, such as deeply embedded sutures necessitating local anesthesia or complex intervention beyond routine removal. New CPT codes have been introduced to address suture or staple removal, especially when anesthesia is required or when performed outside a global period.
Patient Considerations for Billing
Patients with questions or concerns about a bill for suture removal should first review their Explanation of Benefits (EOB). The EOB is a statement from the insurance company detailing how a claim was processed, showing what was billed, what the insurance covered, and what the patient is responsible for paying. It is not a bill itself, but a summary of payment activity.
If the EOB or bill seems unexpected, contacting the healthcare provider’s billing department is a sensible next step. They can offer clarification on the charges, explain how the global period applies, and address any discrepancies. If questions remain after speaking with the provider, reaching out to the insurance company directly can provide further insight into coverage policies and claim processing.