Revenue Cycle Insider

Question: A patient reports to the emergency department (ED) with a pilonidal cyst. What surgical CPT^® codes would be appropriate to report for the ED physician’s treatment of these cysts?

Missouri Subscriber

Answer: The type of treatment the ED physician provides will guide your code choice. The physician could drain the cyst, excise it — or both.

If the provider performs only an incision and drainage (I&D) of the cyst, you’ll report 10080 (Incision and drainage of pilonidal cyst; simple). During this procedure, “the provider opens (incises) and drains the contents of a pilonidal cyst,” according to Codify. If the notes indicate the I&D took additional time, a special technique, or more clinical knowledge, you might be able to report 10081 (… complicated) instead.

When the ED physician removes the cyst completely, report either 11770 (Excision of pilonidal cyst or sinus; simple) or 11771 (… extensive). During a 11771 encounter, “the provider excises a pilonidal cyst or sinus that requires extensive dissection into deeper subcutaneous tissues,” reports Codify.

Note: The ED physician will probably never perform a complicated excision (11772 [… complicated]); these cases are sent to the operating room (OR) except in very rare circumstances.

Sometimes, the ED physician will have to perform an I&D prior to excising the cyst. If encounter notes indicate that the physician performed I&D and excision on the same cyst during the same patient encounter, code only the excision — the I&D is considered part of the excision’s surgical package.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC