Wiki 10060 vs 10061

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annevan1213

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Please help me determine the difference. My physician is stating she is charging a complex I&D because she placed packing. I am not sure that is the determining factor. Coder's Desk Reference states Report 10061 for complex or multiple cysts. Here is her procedure note.

I&D of Abscess: Date--4/20/2015

Op consent form signed by patient.

Local anesthesia with 1 % Lidocaine with epi

Pt. Prepped with betadine if not allergic to iodine, and rubbing alcohol.
Using sterile technique, I & D performed with #11 blade.
Abscess opened with hemostats and drained.
Packing gauze applied into wound.
Dressed with gauze.
Procedure well tolerated with no complications.

CPT guidelines aren't clear either.

Thank you!
 
I would use 10060 because the note indicates that there was not multiple abscesses. Dressing/packing the wound does not make it complex. If the physician disagrees, I would have her sign a form (something like a query form) stating that the draining of the abscess was complex.

Hope that helps!
 
Thank you, this does help. I agree that it should be 10060. It was a query form that she described her decision for complex so I quess I have to go with that for now. But I will talk with her about the difference and see if she agrees moving forward.

Thanks!
 
I grabbed this from a previous post on this forum:

Excerpt from CPT Assistant...

Surgery: Integumentary System

Question: Many of the incision and drainage codes (ie, 10060-10140, 10180) include one code for simple procedures and one code for complicated procedures. Does the CPT code set define these terms?

AMA Comment: No. The choice of code is at the physician's discretion, based on the level of difficulty involved in the incision and drainage procedure.

Coders Desk Reference:
The site is gently cleaned with a disinfectant. An incision is made in the center of the abscess or cyst. The site is drained and irrigated with a sterile solution. Then the skin is then closed for a simple abscess. Depending on the depth of the abscess, the physician may insert a catheter or drain for a few days. Code 10060 for a simple or single procedure; 10061 for complicated or multiple procedures. For a complicated abscess, the site is packed with sterile gauze to help the wound heal and prevent further leakage. Complex abscesses may also require subsequent surgical closure.

We have always coded 10061 if the doctor uses packing rather than closing.

Hope that helps.

Jodi
 
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