10060 or 10160 or 26010

1.Paronychia of great toe of right foot
Drained with single puncture with 21g needle in clinic, expressed approx 1ml purulent material, covered with sterile adhesive bandage, patient tolerated without complication.
What code is supported here. No incision done but only drained. It was billed as 10060. Should this be part of E/M?

2.Punch Incision and Drainage:
Anesthesia with 1% lidocaine with epinephrine, total volume 3cc
Incision with 4mm punch. Expression of lesional contents with cotton tip pressure .Bandage. No complications.
What code is supported here. ? Does a punch support 10060. Could not find any Coding articles that say punch is not supported. SO assuming punch is supported?

Thanks in advance for your code suggestions.

Without an incision, it's part of the E&M. It stinks, but the AMA hasn't yet developed a code for a procedure where there's a needle puncture to remove purulent material, or a foreign body. You may be able to support a higher level E&M based on the documentation, however.

So punch is also not considered incision?

priceless said:

So punch is also not considered incision?

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Punch is different than needle. Did he use the punch tool that's generally used for a punch Bx? that's a sharp tool used to make an incision. A needle is generally less effective than a scalpel for complete drainage, especially when thick pus or multi-pocket infections are present. I've seen some blogs/articles that suggest that a needle can be used for I&D, however, CPT assistant indicates: The physician makes a small incision through the skin overlying an abscess for incision and drainage (e.g., carbuncle, cyst, furuncle, paronychia, hidradenitis). The abscess or cyst is opened with a surgical instrument, allowing the contents to drain. The lesion may be curetted and irrigated. The physician leaves the surgical wound open to allow for continued drainage or the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage. Report 10060 for incision and drainage of a simple or single abscess. Report 10061 for complex or multiple cysts. Complex or multiple cysts may require surgical closure at a later date.
I wouldn't consider a needle to be a surgical instrument. Bottom line, if you are comfortable billing out the I&D based on the documentation, and could defend it in a payer audit, then that is what you should do.