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Incision of suspected abscess, no drainage

S

SUEV

Guru
Local Chapter Officer
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208
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Kennebunk, ME
My doc was asked to consult on an ER patient for perirectal pain. He suspected it was a perirectal abscess so made an incision but nothing drained. As a result, he decided it was probably a Bartholin's gland abscess so another doc was called in to drain that. Is the incision billable or would it just be bundled into the ER consult he'll be billing?
 
Because a procedure was performed I would not consider the incision as content to the E&M. I believe I would assigned procedure code 46040 with modifier 52 to show the procedure was partially reduced; meaning drainage was not performed. This shows the intended procedure I&D was attempted but not completely carried out. The diagnosis code would be 569.42 (Anal/rectal pain) which may trigger a denial from the carrier. Medical records should support medical necessity during appeal.
Your other option would be to report the service with an unlisted procedure code, 45999. Reimbursement will be hindered either way since medical records will be needed to support the charge.
 
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