Ob-Gyn Coding Alert

You Be the Coder:

Should You Report the Culture Codes? Find Out

Question: My ob-gyn saw a patient who had pus in the breast and did an incision and drainage (I&D). What are the CPT® codes for a breast smear and a breast culture?

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Answer: You will not be reporting the culture or smear. The lab will choose which lab code to use based on the type of culture the ob-gyn orders. You can find the different kinds listed in the CPT® index under “culture.” The ob-gyn would indicate the lab test he wants performed on the sample he provides. You will, however, report a procedure code for the I&D. The ob-gyn did this to relieve the problem and collect the specimen.

For instance, you might report the I&D with 19020 (Mastotomy with exploration or drainage of abscess, deep) — if that represents the amount of work your ob-gyn performed. You might consider appending modifier 52 (Reduced services) if your ob-gyn did less extensive work. This code has 13.50 relative value units (RVUs) in the office setting.

Another option is 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single]) if the I&D occurred at the skin surface.

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