AHA Coding Clinic® for HCPCS - 2025 Quarter 3; Ask the Editor
Reporting CPT Codes 15853 and 15854
According to the guidance in the July 2023 CPT Assistant , Pages 14-15, add-on codes 15853 , Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code) , and 15854 , Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code) , are intended for practice expense (PE) reporting and must be listed separately in addition to an evaluation and management (E/M) service. The guidance further specifies that, for non-facility reporting, these codes may only be reported in conjunction with E/M office visit codes. However, we see these codes being reported in the emergency department (ED) in conjunction with ED E/M codes 99281 - 99285 . Additionally, the parenthetical notes following codes 15853 and 15854 include the ED visit codes, implying that such reporting is allowable. This raises a key question: If codes 15853 and 15854 are for non-facility reporting only, why do the parenthetical notes indicate that ED E/M codes are reportable with them? Does this mean that these codes are also appropriate for facility-based (eg, hospital ED) reporting? ...
Subscribe or sign in to view the full article.
Article Overview
This article explains recent CPT Assistant guidance related to reporting two CPT add-on services that are tied to evaluation and management encounters. It focuses on the setting of service, practice expense reporting, and the difference between office-based and emergency department reporting considerations. The article is useful for professional coders, billing staff, compliance teams, and revenue cycle personnel who need to understand the scope of the guidance and the code sets involved.
Why This Topic Matters
Accurate handling of these CPT add-on services affects how associated evaluation and management encounters are reported in different care settings. The guidance is relevant for organizations that bill office visits and emergency department services and want to align internal reporting practices with published CPT instructions.
What You Will Learn
- The general CPT Assistant guidance discussed in the article
- How the article frames reporting in office and emergency department settings
- Why the reporting context matters for practice expense-related coding
- Which code sets and service categories are involved
Who Should Read This
- Professional coders
- Outpatient billing staff
- Emergency department coding staff
- Compliance teams
- Revenue cycle personnel
Codes Discussed
Code Ranges Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com