When coding for procedures involving an abscess, you’ll need two pieces of information:
- The location of the abscess
- The treatment method (e.g., incision and drainage, excision) for the abscess
In some cases, you also may need to know the approach (open, percutaneous) the provider uses in treating the abscess.
Know Your Abscess ABCs
An abscess is a collection of pus, a thick fluid that generally contains white blood cells, dead tissue, and foreign bacteria (e.g., Staphylococcus aureus) or other infection. Think of an abscess as a miniature battlefield, where the body’s immune system is fighting against an infection. Both sides take casualties and inflict damage on the surrounding area.
An abscess may occur nearly anywhere on or in the body. For incision and drainage (I&D) of superficial abscess or abscess of the skin at any location, turn to 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia); simple or single
or 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia); complicated or multiple
As specified in the code descriptors, use 10060 for single abscess, or for a small collection of purulent material (e.g., paronychia, or a small cyst around a hair follicle). In such a case, the infection is limited to the superficial subcutaneous tissues. For I&D of multiple abscesses, or for a single large or “complicated” abscess, report 10061. The physician determines whether the abscess is simple/single vs. complex/multiple, and this determination must be supported by documentation. If the medical record is not clear, ask the documenting physician for detail.
Below the Skin Calls for
More Precise Code Selection
For abscesses below the fascia, or skin, coding is much more specific. To select an appropriate code to describe an “internal” abscess, check the CPT® index under the main term “abscess.” You’ll find nearly a full page of entries, categorized primarily by location (e.g., bone, tissue-abdomen, tissue-nasal, etc.). Be sure to explore the index entries to select the most appropriate treatment method (I&D is most common) and approach (if applicable).
For example, if the provider treats an abscess of the kidney, look up the subterm “kidney” under the main term “abscess.” This will lead you to codes 50020 Drainage of perirenal or renal abscess; open
and 50021 Drainage of perirenal or renal abscess; percutaneous
Do not code directly from the index. Confirm your code selection by referencing the full code descriptor in the tabular portion of the CPT® codebook.
Note also that within the musculoskeletal section of CPT®, there is a general incision code (20005 Incision and drainage of soft tissue abscess, subfascial (ie, involves the soft tissue below the deep fascia
), as well as codes specific to: neck, shoulder, upper arm and elbow, forearm and wrist, hand and fingers, pelvis and hip joint, femur and knee joint, leg and ankle joint, and foot and toes. For example, for I&D of an abscess below the fascia of the foot, any of the following may apply:
28001 Incision and drainage, bursa, foot
28002 Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space
28003 multiple areas
28005 Incision, bone cortex (eg, osteomyelitis or bone abscess), foot
Proper code selection depends heavily on the provider’s documentation. For example, the procedure note may specify a “deep” abscess, but you should still check with the performing provider to determine if the incision was below the fascia, as this could mean the difference between reporting 10060–10061, or a code describing a more extensive procedure.