Wiki I & D CPT and Diagnosis

[KristieStokesCPC]

Our PA did an I & D (code 10060) with a diagnosis Abscess of Finger (681.00). Medicare has denied for CO-11 inconsistent w/the procedure. I also tried the other codes we had (686.9 and 915.6), none of which has worked. Please help...

Thank you

 

[aguelfi]

Could the problem be more of who performed the procedure? A PA instead of the doctor??

 

[Lisa Bledsoe]

I would call your carrier...we have recently had A LOT of inappropriate denials since our carrier changed. We have to fight with them DAILY!

 

[KristieStokesCPC]

It's not who performed it because we bill under our physician, since she oversees the PA. I will call the carrier. Thank you for you help .

 

[FTessaBartels]

cpt 26010

Would CPT 26010 or 26011 fit the procedure that was documented?

Encoder Pro lists the lay descriptions as follows:
The physician drains an abscess located in a finger. In 26010, the physician lances an abscess located in the cutaneous tissue of a finger. In 26011, the abscess just reaches deep subcutaneous tissue and requires debridement and irrigation. The wound may be left open to drain.


F Tessa Bartels, CPC, CPC-E/M