ED Coding and Reimbursement Alert

Answer: The straightforward drainage of a paronychia would be coded out with 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single).  In this case, the doctor treated a large collection of pus located at the nail fold that required a 7mm incision and packing; usually a paronychia would require no more than a few millimeters of incision and no packing. Therefore, one could make the argument that this was not "simple" and that 10061 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple) might apply.

You also need to determine if a separately identifiable E/M service was provided. Most coders would feel comfortable submitting an E/M code if the documentation mentioned additional exam components, or screening for advancing or systemic infection. In this particular case, the emergency physician separately examined the finger and hand for signs of lymphangitis, cellulitis or a tenosynovitis with perhaps even a consideration of an osteomyelitis above and beyond the drainage of the paronychia. As long as the physician documented all findings, with an Expanded Problem Focused history and exam, as well as moderate medical decision making (due to the prescription) you would likely report 99283-25.