The Scoop on Abscess Coding

The Scoop on Abscess Coding

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

1. The location of the abscess

2. The treatment method (e.g., incision and drainage, excision)

In some cases, you also may need to know the approach (open, percutaneous) the provider uses during treatment.

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 …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 of a single large or “complicated” abscess, turn to 10061. The determination of simple/single vs. complex/multiple is the physician’s, and must be supported by the available documentation. If documentation is not clear, ask the documenting physician for detail.

For abscesses below the fascia, coding is much more specific. To select an appropriate code to describe “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.). Explore the index entries to select the most appropriate treatment method (incision and drainage is most common) and approach, if the options are available. Do not code directly from the CPT® index. Rather, confirm your code selection by referencing the full code descriptor in the tabular portion of the codebook. 

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 a below the fascia abscess 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 Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas

28005 Incision, bone cortex (e.g., osteomyelitis or bone abscess), foot

Code selection depends on the provider’s documentation. For example, the procedure note may specify a “deep” abscesses, but you should still check with the performing provider to determine if the incision went below the fascia, as this could mean the difference between reporting 10060-10061 and a code describing a more extensive procedure.

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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