Two Coding Tidbits for Better Abscess Coding

When coding for procedures involving an abscess, you’ll need two pieces of information:

  1. The location of the abscess
  2. 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.
Caution: 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.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

One Response to “Two Coding Tidbits for Better Abscess Coding”

  1. Kimberly Jolivette Williams says:

    Hello Rene Dustman
    I am a bit confused on when to use 20005 vs 10061 on this case. Please review it and advise… You may call me if necessary. Thanks
    Abscess right ankle and foot
    Drainage of abscess right lateral ankle and dorsal foot
    This 72 y.o. female has a history of right ankle swelling and mass. MRI revealed a possible abscess and she is brought to the operating room for drainage.
    The patient was brought to the operating room and after adequate general anesthesia had been obtained was prepped and draped in usual fashion using PCMX. The area of abscess was evaluated and an incision was made in the lower lateral ankle and carried nearly to the foot over the area of maximum edema. Approximately 200 cc of seropurulent fluid was drained. Cultures were taken. Wound was then irrigated with copious amounts of saline and manual exploration was carried out to break up any residual tracts and abscesses. Once this was accomplished, the wound was dressed using Aquacel Ag, 4 x 4, Kerlix, and an Ace. The patient was taken to recovery room in stable condition