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Blister, incision & drainage, what code?

  1. #1
    Unhappy Blister, incision & drainage, what code?
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    What CPT code would I use for incision and drainage of a blister? It's not from a burn, I think the patient was overweight to the point he has blisters on his foot. I don't think it's 10060. Patient has Medicare. Help appriciated

    Blister, toes without infection
    Fluid-filled sacs that look like fleshy bubbles on the skin. located on left 2nd, 4th, 5th toes and right 4th toe
    Medical Decision Making: Blister, toes without infection , observe
    POC: Recommendation is Incision and drainage- alcohol wipe to clean the procedure field, 25G needle to
    dilate the pore, yellowish water expressed. discussed with patient should loss his weight. Needle used to incise and drain 5 blisters on bilateral feet).

  2. #2
    Default
    Unfortunately, no code exists. I know this sounds bizarre, but in all my years of derm coding, I have NEVER found a code for billing I&D on something other than abscess, cellulitis, carbuncle, furuncle, cheilitis, or hidrenitis (all of which involve infection).

    Your two options are to try 17999 (unlisted dermatology procedure) and send records, or just include the work of the I&D in your E/M code.

  3. #3
    Default
    I figured this would happen but medicare denied the I&D as medically unnecessary, even with a secondary diagnosis "disturbance of skin sensation" guess I'll have to try the unlisted procedure coded. Has that ever worked for anyone?

  4. #4
    Default
    Is this a new patient being seen for the blisters? Are you billing an E&M? These could all have an influence of what you bill. Also, not sure what the reimbursement is for the unlisted code, but would it be worth to go through all of that if you could just bill an E&M code?

  5. #5
    Default
    Quote Originally Posted by ABonnell CPC View Post
    Is this a new patient being seen for the blisters? Are you billing an E&M? These could all have an influence of what you bill. Also, not sure what the reimbursement is for the unlisted code, but would it be worth to go through all of that if you could just bill an E&M code?
    I billed 99203 with it but that's because the Dr did all the separate work for it unrelated to the blisters.

  6. #6
    Default
    I just found a code!!! (Where has it been hiding from me???)

    10140 is "incision and drainage of hematoma, seroma, or fluid collection." A blister is a fluid collection, right, so there's your code!

  7. #7
    Unhappy
    Quote Originally Posted by CatchTheWind View Post
    I just found a code!!! (Where has it been hiding from me???)

    10140 is "incision and drainage of hematoma, seroma, or fluid collection." A blister is a fluid collection, right, so there's your code!
    Unfortunately medicare doesn't cover 10140 if it's the blister code.

    Medicare LCD, for new york at least, says "CPT code 10140 is payable only for ICD-9-CM codes 924.10*, 924.20, 924.21, 924.3, 924.4, 924.5, 928.10*, 928.20, 928.21, 928.3, 928.8, 998.11, 998.12, and 998.13."

    Which are all contusion or injury codes, none of them are blisters..

    Maybe its the appropriate code for other insurances?

    http://www.cms.gov/medicare-coverage...AAAAAAA%3d%3d&

  8. #8
    Default
    Shoot I just noticed something. Shouldn't I have used 709.8? Because that code includes the description "multiple blisters" if I'm correct?

    Per medicare LCD "CPT codes 10060, 10061 or 10160 are payable for ICD-9-CM codes 681.10, 681.11, 682.7, and 709.8 only"

    I used 917.2 which was under the superficial injury blister code and I'm thinking the patient's blister shouldn't be considered superficial injury?

    The patient has blisters on his toes because he was overweight and pretty much put too much pressure on his toes from standing. Is that considered injuring himself or a skin disorder?

  9. #9
    Default
    Regarding 10140, our Medicare LCD (Florida) has no restriction against using it for blisters.

    As for the diagnosis, I agree with your initial decision to use 917.2 (superficial injury: foot and toe: blister without mention of infection). 709.8 is only for non-traumatic blisters and, as you pointed out, this actually is an injury, not something caused by a disease.

    So this leaves you with CPT-dx match that your Medicare does not allow! Where to go from here??? I don't know...

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