Wiki I&D documentation guidelines for coding 10060 vs 10061

[gfarrell]

I am looking for an "official" resource that actually provides guidance on what documentation constitutes a simple I&D (10060) versus a complex I&D (10061). I'm finding a variety of opinions and that a drain/packing takes the coding to complex 10061 but then I'm finding that if the physician states it was a complex then that is all that is needed to code the 10061. In order to fully educate the physicians we have, I need a official resource on what the documentation should state and the details it should provide. All of the physicians are listing details of size/site/anesthesia/procedure details/ etc but the only difference is some do not state the complexity and others do. Any one have any insight on this or a official website I can review. Thanks in advance!

 

[Chelle-Lynn]

Unfortunately, there isn’t any guidance in the guidelines or from the AMAin the form of a CPT® assist to help determine simple versuscomplicated. The most basic and common definition accepted is:



· 10060 for incision and drainage of asimple or single abscess. Simple lesions are typically left open to drain andheal by secondary intention.

· 10061 for incision anddrainage of a complicated or multiple abscesses. Complicated abscesses requireplacement of drain or packing.


Additional factors could be the depth or the abscess, appearance,sign/symptoms, etc. Remember there are also specific codes for certaindeep abscess such as 27301, etc.