Determine Degree of Drainage in This Parotid Abscess Encounter
Question:Our otolaryngologist admitted a patient with parotitis to the hospital. Three days later, the patient developed a parotid abscess that required draining. After examining the patient on rounds, the otolaryngologist made the decision to drain the abscess. How should I go about coding this? Alabama Subscriber Answer: Coding for this is dependent on the complexity of the drainage. If the provider drained the abscess at the patient’s bedside, you would use 42300 (Drainage of abscess; parotid, simple). But if the provider found the patient’s abscess was in the deeper areas of the parotid gland, or that there was more than one abscess or several loculations within the gland trapping pus, your provider may opt to take the patient into surgery. In this case, you should report 42305 (Drainage of abscess; parotid, complicated). Your choice of 42300 or 42305 will also affect the modifier you will append to 99231-99233 (Subsequent hospital care, per day…). If your provider performed and documented the hospital care as significant and separate from the drainage, they could append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the 9923x, though the payer may include the evaluation and management (E/M) service in the allowance for 42300 if there is no separate diagnosis. But if you report 42305, you will append modifier 57 (Decision for surgery) to the 9923x. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
