I & d

BABS37

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I'm thinking this is just an I & D of an ulcer-abscess (10060) but my co-worker wants to bill a 49021-but I just don't think that's what the physician did.

..."general anesthesia was induced and abdomen was prepped and draped sterily. An elliptical incision was made around the central necrotic ulcer and this was excised. Subcutaneously about a 5-10 cc pocket of purulent fluid was encountered, this was cultured and explored digitally to break up any loculations. The area was packed with guaze."

Any advice on which direction to go?
 

LindaEV

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if it was packed it could be considered a "complicated" I&D, which would be 10061. But...he says he excised the ulcer in which case you might want to consider an excision code.

This ulcer was on the abdomen??
 

BABS37

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hmmmm well, his post op diagnosis was soft tissue abscess, left lower quadrant abdominal wall... does that help? That's the whole op note too.
 

Lujanwj

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Your Dr stated Subcu. Since there's not an I&D in Abdominal section 22900, and you can't match the description of 20005 of being subfascial, you'd use 10060/1

I'm not sure what "packed" means but I wouldn't use that as justification for it being complicated(10061). Personally, I'd talk with the dr and tell her/him that they need to dictate that it was complicated, if it was. If not, code simple.

CPT Assistant 12/06

Q: Simple procedures and Complicated procedures. Does the CPT code set define these terms

AMA Answer: No. The choice of code is at the physician's discretion, based on the level of difficulty involved in the incision and drainage procedure.

Good Luck!
 

LindaEV

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Lujanwj

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Thanks for posting those links. I've seen a few of them before in researching the same issue. The problem with those links are they are just peoples opinions of what they think simple vs complicated means. The AMA doesn't say the same thing and, as a coder, I must go by what the AMA says.

The problem with some of those statements is, they are not always true. There are times when placing a drain could be considered simple and on the flip-side an I&D that's not packed could still be considered complicated. From a coding stand point, I'd consider discussing with DR about documenting simple vs complicated on OpNote to be in compliance with AMA guidelines.

Thanks for sharing. You've got some really good posts on here.
 
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