Pediatric Coding Alert

Here’s why these services aren’t typical I&Ds.

A patient reporting to the pediatrician for treatment of a cyst will typically require services represented by the traditional incision and drainage (I&D) procedures.

There are times, however, when your provider might perform an I&D-type procedure that you won’t code with 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) or 10061 (… complicated or multiple).

Read on for a quick primer on coding for a couple of these services — just in case your pediatrician performs an I&D that doesn’t fit into the traditional coding categories.

Use 10040 for Acne Procedures

Acne, a condition often associated with adolescents, could be an issue for some pediatric patients. If the provider performs acne surgery, you’ll report 10040 (Acne surgery [e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, pustules]), explains Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, CEO of Edelberg + Associates in Baton Rouge, La.

During a 10040 service, the provider cuts and extracts the contents of severe acne lesions, Edelberg continues. Another 10040 surgery is comedo extraction.

“A closed comedo — a whitehead — is more embedded into the skin than an open comedo, or a blackhead,” Edelberg says. Comedo extraction could involve the use of a comedone extractor to remove the contents. Since whiteheads are more embedded into the skin, they are often require incision before the physician can use the comedo extractor.

Anatomy Can Clue You in on Pilonidal Cysts

If you see an I&D claim that includes the term “pilonidal cyst,” have 10080 (Incision and drainage of pilonidal cyst; simple) or 10081 (... complicated) at the ready. You’ll report 10080 or 10081 for pilonidal cyst I&D, depending on encounter specifics.

Characteristics: A pilonidal cyst is typically small, in the cleft at the top of the buttocks. Pilonidal cysts often contain hair, dirt, and/or debris.

When deciding whether a pilonidal cyst procedure is simple or complicated, Edelberg recommends applying the same set of rules that you use for other types of cysts or abscesses. Codes 10080 and 10081 are just more specific to the location of the wound (buttock cleft), Edelberg says.

However: As with 10060 and 10061, the line between simple and complicated pilonidal cyst I&D will ultimately be drawn by your providers. According to the December 2006 CPT^® Assistant, simple versus complicated pilonidal cyst I&D is at the physician’s discretion based on the level of difficulty.

Best bet: Learn the typical differences between 10080 and 10081 coding scenarios, so you can spot potential pilonidal cyst I&Ds. Also, let your providers know that it is up to them to decide whether 10080 or 10081 is appropriate.