I&D of intraoral abcess

[skonas]

ICD10: K11.20 Sialoadenitis
Procedure note:
"Procedure (Incision and drainage of intraoral abscess) completed in clinic. After discussion of risks, benefits and alternatives for the procedure, benzocaine 20% was sprayed into the oropharynx. The right buccal mucosa was injected with 1% Lidocaine with 1:100,000 epinephrine. A dilator was used to identify and enter Stenson's duct. A 15 blade was then used to incise the buccal mucosa until the abscess cavity was entered. About 1ml of purulent drainage but no stone was seen. The site was irrigated with 1:1 sterile saline and hydrogen peroxide followed by sterile saline. The patient was asked to rinse and gargle copiously with cold water until minimal bleeding was noted. The patient tolerated the procedure well."

I believe the cpt should be 42300 but my provider thinks it should be 42650. What do you think?

 

[cpc2007]

Hi

After reviewing the note, I agree with the provider's code of 42650. I would also consider adding 40800 for the I&D of the abscess in the buccal mucosal tissues (the mucosa lining the cheek) which is considered part of the vestibule of the mouth. 42650 includes dilating a salivary duct only but doesn't include an incision or a drainage procedure.

The reason I wouldn't go with I&D of the parotid is that the CPT appears to refer to I&D of the parotid gland, but the provider is dilating the "Stenson's duct" (aka the parotid duct) rather than the parotid gland and is incising and draining an abscess in the buccal mucosa.

I hope that helps - have a good night.

Kim
www.codingmastery.com