Simple Suturing: Best Practices and Documentation

00:01 We're going to start with some summary items that I think are important.

00:05 I hate to mention, but you do see things like this being done well, but not always best practices.

00:14 So here are some things to avoid.

00:17 You want to make sure that you're spending plenty of time cleaning the wound, because if you don't, this is going to be a higher risk for infection. You also want to make sure that your sutures are not too tight.

00:30 You want to make sure that it closes the wound, but not strangulating the tissue.

00:35 So you want to make sure it's not blanching.

00:38 Also, you want to make sure that your sutures are even.

00:42 You can see the spacings is about the same.

00:45 And how much on either side of the laceration is about the same, so that you don't have any dehiscing or improper closure of the wound.

00:55 Sometimes you can get a lip on it and that's going to cause more scarring.

01:00 Again, poor not securing.

01:03 You want to make sure that you're doing at least three throws.

01:07 A throw is considered when you wrap around the needle driver twice and then pull through with the opposite side of the suture.

01:16 That's considered one throw.

01:17 As you noticed in my technique, I did three throws.

01:22 Picking the wrong suture material is going to be a problem.

01:25 This can cause infection.

01:28 It can cause possible closure failure.

01:32 And so you want to make sure that we're using the right material.

01:37 So making sure you're using non absorbable and you're either going to be using nylon silk or polypropylene.

01:45 And then remember your sizing.

01:47 Remember the higher the number the smaller the dynamic.

01:51 And also the smaller the tensile which is the strength.

01:55 You want to make sure that you're talking to your patient about wound care.

01:59 That's very important that they understand that before they leave your office to make sure that this does not get infected and cause other problems.

02:08 Lastly, not realizing when you shouldn't suture.

02:12 There is no harm in saying I do not feel comfortable.

02:16 This is not a laceration that I should suture.

02:20 So think about those that are mangled or those that are on the face, lip or eye. Those need to be referred as always.

02:27 When we do any procedure, you need to code correctly.

02:31 So you need to make sure that you're using your modifiers with the specific location and whether it was a simple or a complication repair.

02:40 You want to be using your HCPCS codes for all the supplies you use.

02:45 It's important that you put the lidocaine, the suture material, those types of things, your CPT codes, your primary codes for injection, and the anesthetic agents that you used.

02:57 And you also want to use your ICD-10 diagnosis codes specific to the procedure that you were performing.

03:05 The biggest point about all the coding is that you have to provide detailed information in your documentation about your wound.

03:13 You want to measure the wound, how big the wound was, how many layers. So being able to document, was it down to the muscle tissue? Was it subcutaneous? Where did it go? How you sutured it. Was it simple suture? What type of suture did you use? How many sutures did you put? A nd so forth. You want to document how the accident occurred.

03:37 All that information is very important, not only for medical records and the person who may come behind you or see that patient, but also for the coders for billing purposes, so that they have that documentation to build accurately.

03:54 Simple suturing is a skill like any other that requires practice.

03:59 The research is clear that without practice, competency falters.

04:03 So be sure to plan how you can maintain your practice on this one.

04:08 Find refresher courses and keep reading on the latest research on best practice.

04:14 You can also find suture boards such as this to practice on at home as well.

04:19 Thank you for watching.