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Complex verses simple I & D

smwermter

Networker
Messages
58
Best answers
0
If an incision and drainage is done and it is packed with gauze strip how are you coding? Complex 10061 or simple 10060? CDR states that it is at the discretion of the physician whether procedure is complex. So, our question is if the physician does not specify complex but it is incised, drained and packed with the gauze strip is it appropriate to code as complex?

Thanks for the help!!:)
 

Christine Bekker

Contributor
Messages
16
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0
I recently read an article explaining that to cover the cost of your re-packing of gauze the Complicated I&D code is more appropriate since typical follow-up care is included during the global period. I wish I could remember who wrote the article, I believe it was in a Coding Alert. In addition, the Ingenix 2008 Coders' Desk Reference describes the complex procedure as, "...the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage."

I hope this helps.
Christine
 

amitjoshi4

Guru
Messages
113
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0
I agree with Christine. As per CPT assiatant also

Incision and Drainage Abscess
CPT Assistant, Special Issue 2005, page 7

Question:

If an incision and drainage is performed for one abscess on the arm and one on the leg, would it be appropriate to report code 10060 two times? Or should code 10061 be reported one time?

AMA Comment:

Many of the incision and drainage (I & D) procedures include one code for simple procedures and one code for complicated procedures; however, the terms simple and complicated are not defined in the CPT codebook. Rather, the choice of code is at the physician's discretion, based on the level of difficulty involved in the incision and drainage procedure. It is important to note that code 10060, Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single, should be reported for a simple or single I & D procedure.

Code 10061, Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple, should be reported for a complicated or multiple I & D procedure.

I hope this will work for you.

Thank You
 

deja08

New
Messages
9
Best answers
0
I agree that if packing is used it should be complicated, however, in a recent audit, I received an error for coding it this way. I thought that because the packing involved a return visit for removal, it was considered as complicated. I read an article in the ED Coding Alert that pointed to complicated also. Even though I received an error for this, I am still coding it the same way until I find something in writing that states different.

Gina
 

billie

Contributor
Messages
14
Location
Pueblo West, CO
Best answers
0
urgent care

Thank you both for your help!!

Have a great 4th!! :D
Hi
can anyone help with urgent care coding of claims? They use a 99058 for emergency visits when documentation does not support this? Should we be billing for syringes when an injection was given or the administration code?
Also can we bill for local anesthesia when they had a minor surgery?
 
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