Primary Care Coding Alert

Question: A patient was seen for an incision and drainage of a cyst. She returned to the office two days later due to excessive drainage of pus. The doctor packed the wound with Iodoform gauze. Is the packing included in the procedural code describing the original visit? If not, how should I code it?

Heather Vatsko
Spring Grove, Pa.


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  Answer: Assuming that the original procedure was billed using either code 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), several options are possible.

Following strict CPT guidelines , 10060* is a starred surgical procedure, indicating that associated pre- and postoperative services are not included in the service. Therefore, all postoperative care is billed on a service-by-service basis. This means that your physician could bill an office visit for packing the wound with Iodoform gauze (99201-99205, new patient or 99211-99215, established patient).

However, 10061 is a nonstarred surgical service. If it was assigned to describe the original procedure, the global surgical package concept applies. The surgical package includes the pre-op exam, local or regional anesthesia if needed, the surgical procedure itself and normal uncomplicated postoperative care. The postoperative period for this procedure for Medicare patients is 10 days, although this is not universal with all carriers. Therefore, if code 10061 was billed, global package rules would apply for the packing of the wound two days postoperatively and the office visit would be a free service.

One exception to this would occur if the excessive drainage of pus described above were not considered to be normal uncomplicated postoperative care. If it were not characteristic of normal care, it would fall outside of global package and could be reported.

This issue becomes complex because of the concept of starred procedures. Because starred procedures are an exception to global package rules, not all carriers treat them the same way. According to Medicare guidelines, for instance, both 10060 and 10061 have 10 global days. Therefore, if this patient is covered by Medicare, this office visit would be considered part of the global package and not billable.

Most commercial and managed-care insurance, on the other hand, will follow the CPT guidelines. Nonetheless, their policies may also vary, and you should check with the carrier in question.