Wiki 10060

[stephen.schofield12@gmail.com]

I'm a new coder and I work for a general practitioner NP and last week he did a simple I&D of a cutaneous cyst in the office. The man had no insurance and was self pay so whether we coded this particular situation correctly really didn't matter (no risk of insurance rejection). However, I see potential for this to come up again. So I have two questions. First is it proper to bill for an office visit in addition to the code for the specific procedure and also he noted that he did a simple two suture closure. Is this included in the code for 10060 or is there a need to code for a simple closure. Thanks in advance for taking the time to respond.

Steve

 

[fwnewbie]

Everything should be coded whether there is insurance or not, and a simple closure is included in most excisions but it's not mentioned with the I&D codes. Under "simple closure", the description is for wound closure like lacerations and not a surgical wound. As I look at this information I'm inclined to say no to coding the closure because he is just repairing the surgical wound.
As for setting up a pricing tool for the next time, figure out the cost of supplies (especially suture because it can be expensive) and let the patient know what to expect before the procedure. I would encourage the use of steri strips next time as a cheaper alternative.

 

[Pam Warren]

I'm a new coder and I work for a general practitioner NP and last week he did a simple I&D of a cutaneous cyst in the office. The man had no insurance and was self pay so whether we coded this particular situation correctly really didn't matter (no risk of insurance rejection). However, I see potential for this to come up again. So I have two questions. First is it proper to bill for an office visit in addition to the code for the specific procedure and also he noted that he did a simple two suture closure. Is this included in the code for 10060 or is there a need to code for a simple closure. Thanks in advance for taking the time to respond.

Steve

Hi, Steve. An I&D is a minor procedure, and CCI edits exclude an E&M at the same encounter as a minor procedure unless you can show 'significant and separately identifiable' to append the -25 modifier. Also within the CCI edits is a column 1 column 2 warning indicating that if you bill the I&D with the associated repair, only the I&D will be paid. The only time a modifier to override the edit would be appropriate is if the repair was done for another reason than to close that incision.

Whethere there is insurance or not is irrelevant, although some payers have differences in which codes you report for which services. (for example, the flu shot administration codes for Medicare vs. commercial). Beware of tweaking the bill based on the patient's financial situtation, unless you have a financial aid policy. You must code/bill everyone consistently regardless of payer/financial status, but with a written financial aid policy you can make adjustments after the fact, based on financial need.

 

[CatchTheWind]

Be aware though that some payers won't pay for 10060 or 10061 if the diagnosis is "cyst." These codes are only for abscesses. (For those that won't pay it for cyst, we use 10140, which is drainage of "fluid collection."