ED Coding and Reimbursement Alert

Focus on complexity to choose between 10060 and 10061 If you can differentiate between a simple and complicated I&D, you-re worth your weight in gold. Code 10061 brings in more dollars than 10060. There are different codes for simple and complicated incision and drainage (I&D), as well different code sets for pilonidal cyst treatment. When a patient requires repair in the ED, you have to check the documentation to determine the complexity of the I&D. Master the ins and outs with these tips. Code Single Dermal I&Ds With 10060 Before selecting the proper I&D code, you will need to decide the complexity of the procedure. CPT indicates that for simple (or superficial) I&Ds, you should report 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia]; simple or single). -Simple I&Ds involve abscesses of the epidermis, dermis or subcutaneous layers,- says Jeffery F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga. Example: The ED physician treats a patient who has been scratching at an insect bite on his lower arm and now has pus draining from it. The abscess is in the dermis. The physician cleans the skin around the wound and makes a small scalpel incision. The physician then drains the pus, and cleans and dresses the wound site. Linzer says this will qualify as a simple I&D. You should report the following codes: 10060 for the I&D. 682.3 (Other cellulitis and abscess; upper arm and forearm) linked to 10060 to represent the abscess. 913.5 (Superficial injury of elbow, forearm and wrist; insect bite, nonvenomous, infected) linked to 10060 to represent the insect bite. Note: If the physician performed a significant, separately identifiable E/M service in addition to the I&D, report the appropriate-level E/M code with modifier 25 attached, Linzer says. Suppose notes indicate a level-three E/M in this example. On the claim, you would include 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem- focused examination; medical decision-making of moderate complexity) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached.
Net More $$ by Recognizing Complex I&Ds Patients will also report to the ED for complicated (or multiple) I&Ds. When this occurs, you should choose 10061 (... complicated or multiple) for the service, says Greer Contreras, CPC, senior director of coding for Marina Medical Billing Service Inc. in California. Bottom line: Coders who can differentiate between a simple and complicated I&D are of great value, because 10061 [...]