General Surgery Coding Alert

Question: Prior to excision, the surgeon had to incise and drain a pilonidal cyst. May we report the I&D separately, or is it included in the excision? Arizona Subscriber Answer: No, you cannot report the incision and drainage separately. CMS guidelines set forth in the national Correct Coding Initiative (CCI) state, "In cases where, in the course of an excision of a lesion, an area of involvement is identified which requires drainage, either as a part of the procedure or to gain access to the area of interest, coding/billing for incision and drainage of this fluid collection would be inappropriate if the excision or other procedure is performed in the same session." An exception could occur if the I&D and excision occur at different sessions. For example, if the surgeon encounters extensive cellulitis around the cyst, which prevents excision, he may perform I&D (10080-10081, Incision and drainage of pilonidal cyst [...]