ED Coding and Reimbursement Alert

Question: The ED physician performs a level-four E/M service for a patient and diagnoses a peritonsillar abscess. Notes indicate that the physician aspirates the abscess to confirm the presence of pus, and then incises and drains it. Is this a 10060 incision and drainage (I&D)?

Minnesota Subscriber

Answer: These types of abscesses have their own I&D codes. For this encounter you would report the following codes:

• 42700 (Incision and drainage abscess; peritonsillar) for the I&D

• 99284 (Emergency department visit for the evaluation and management of a patient, which requiresthese 3 key components: detailed history; a detailed examination; and medical decision making of moderate complexity ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99284 to show that the E/M and aspiration were separate services

• 475 (Peritonsillar abscess) appended to 42700 and 99284 to represent the patient's abscess.

As you can see from the 42700 descriptor, it is a more accurate code choice than 10060 (Incision and drainage of abscess [e.g., carbuncle, supprative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia; simple or single]) for this particular I&D.