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I&D complicated vs simple

chrissyr

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Hey guys,
What is the difference IN 10060 AND 10061 criteria wise?
The coder's desk reference says 10061 if complicated and/or multiple. And that physician may do packing. But can a single abscess w/o packing be complicated d/t wound culture being done?
 

Mojo

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I would code it 10060. I look for the insertion of packing or placement of a drain or breaking up of loculations for 10061.
 

SusanBrown

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what if its packed, culture taken but not much more documentation than that. The area is on the back and its only stated as infected cyst
 

Mojo

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what if its packed, culture taken but not much more documentation than that. The area is on the back and its only stated as infected cyst
Yes, as long as there is documentation of an incision and drainage. Providers often do not document simple or complicated so we have to look for packing, a drain and probing of loculations.

An article in the ED Coding Alert states:
Although you may think determining when to report complicated I&D will be difficult, rest assured: it’s easy. Look for these two elements: multiple incisions are required, or the abscess is complicated by the presence of an infection, says Pohlig.

You could also turn to 10061 if the I&D takes an unusual length of time to finish, is especially deep, or requires drain placement, packing, placement of wicking material or subsequent wound closure.
 

chrissyr

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Thanks for your help. One more question though :)

What if the only documentation is: 2x2 abscess lower leg 2% lido used to anesthesize(sp?)
incision made ;purulent material expressed; wound culture obtained

What would you code this?
 
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10060

Thanks for your help. One more question though :)

What if the only documentation is: 2x2 abscess lower leg 2% lido used to anesthesize(sp?)
incision made ;purulent material expressed; wound culture obtained

What would you code this?

I would code this as CPT 10060.

F Tessa Bartels, CPC, CEMC
 
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