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I&D Definitions

  1. #1
    Default I&D Definitions
    Exam Training Packages
    I was asked by one of our clinic managers, if I could find a clear cut explanation of the difference between "Simple" and "Complicated", for the purpose of distinguishing 10060 from 10061, and I thought I'd check here first...

    I know that multiple abcesses qualify as complicated, but what kind of things would make a single abcess 'complicated', as opposed to 'simple'? I didn't find much in the guidelines about it...

    Also, any thoughts on how to report the I&D if they do a culture on the contents, and send it to pathology? Still an I&D with a separate lab code, or is the culture/path included? Or does it become something else (eg, another procedure altogether) when the stuff being drained is analyzed? This is the one place in the book that there's not much guidance given, so I'm not sure where to start...

    Hope that made sense...Any help is appreciated! Thanks!

  2. #2
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    Tacoma, WA
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    Quote Originally Posted by btadlock1 View Post
    I was asked by one of our clinic managers, if I could find a clear cut explanation of the difference between "Simple" and "Complicated", for the purpose of distinguishing 10060 from 10061, and I thought I'd check here first...

    I know that multiple abcesses qualify as complicated, but what kind of things would make a single abcess 'complicated', as opposed to 'simple'? I didn't find much in the guidelines about it...

    Also, any thoughts on how to report the I&D if they do a culture on the contents, and send it to pathology? Still an I&D with a separate lab code, or is the culture/path included? Or does it become something else (eg, another procedure altogether) when the stuff being drained is analyzed? This is the one place in the book that there's not much guidance given, so I'm not sure where to start...

    Hope that made sense...Any help is appreciated! Thanks!
    The only thing I could find that differentiated the two is this statement in the description in Encoder Pro "Complex or multiple cysts may require surgical closure at a later date." I guess the provider makes the distinction whether it is simple or complicated. Of course if there is more than one cyst it becomes complicated.

    As to culturing the contents, the providers I have worked with generally will send a culture if the contents look suspicious for infection, or if they just want to be sure it is clear. I don't believe that changes the procedure, just means the lab can bill for culturing the sample.

    That is all I have to offer!
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Location
    Milwaukee WI
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    4,466
    Default Per Comprehensive Specialty Guide
    Per my Contexo Media Illustrated Coding & Billing for General Surgery ... (expert edition, 2011)
    "Use 10061 for incision and drainage of a copmlicated or multiple abscesses. Complicated abscesses require placement of drain or packing. (emphasis added by FTB)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
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    Quote Originally Posted by FTessaBartels View Post
    Per my Contexo Media Illustrated Coding & Billing for General Surgery ... (expert edition, 2011)
    "Use 10061 for incision and drainage of a copmlicated or multiple abscesses. Complicated abscesses require placement of drain or packing. (emphasis added by FTB)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Excellent - thank you both!

  5. #5
    Location
    Alexandria, LA
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    CPT Assistant (Dec 2006) said that "choice of code is at the physician's discretion, based on the level of difficulty involved in the incision and drainage procedure". Your physician should document whether it was simple or complicated.

  6. #6
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    Quote Originally Posted by donnajrichmond View Post
    CPT Assistant (Dec 2006) said that "choice of code is at the physician's discretion, based on the level of difficulty involved in the incision and drainage procedure". Your physician should document whether it was simple or complicated.
    Unfortunately, they were the one needing to know!
    I think they have a good idea of what they feel is simple or complicated, but they were unsure of how it's viewed from an 'official' standpoint - I'm glad they asked for clarification, really, just because it's easier to set boundaries, than leave things open to interpretation - especially when you've got as many providers as we do.

    I've learned that some providers' descriptions of their work, are pretty spot-on with CPT/ICD-9/CMS/etc. code descriptions and rules, but others...not so much - and there's no telling which way the estimate might go. Too low, and they lose out on reimbursement, but too high, and it's a compliance risk - taking the guesswork our makes it easier on me, at least! I appreciate the insight - it gives them some room to go for the higher code, in the event that they encounter a really complex I&D, that for whatever reason, may not require a drain or packing. Thanks!

  7. #7
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    Brandi,
    This is what I would expect to see in the documentation of a 60:
    Single, Small or Small Localized Collection, opened, drained, irrigated, left open or no packing. Dressed. Released.

    This is what I would expect to see in the documentation for a 61:
    Single or Multiple, opened, drained, irrigated, probed to remove\break-up or dislodge purulent. Dressed. Return in xx for packing or drain insertion.

    I would allow a 61 if the physician does anything other than open, drain, irrigate. Especially if they intend the pt to return for packing or drain insertion. The physicians I work for will not insert a drain on the same day. And everything is sent to path irregardless.

    Hope this helps.
    P.

  8. #8
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    Quote Originally Posted by Oceanlivin View Post
    Brandi,
    This is what I would expect to see in the documentation of a 60:
    Single, Small or Small Localized Collection, opened, drained, irrigated, left open or no packing. Dressed. Released.

    This is what I would expect to see in the documentation for a 61:
    Single or Multiple, opened, drained, irrigated, probed to remove\break-up or dislodge purulent. Dressed. Return in xx for packing or drain insertion.

    I would allow a 61 if the physician does anything other than open, drain, irrigate. Especially if they intend the pt to return for packing or drain insertion. The physicians I work for will not insert a drain on the same day. And everything is sent to path irregardless.

    Hope this helps.
    P.
    That's great, too! You guys are awesome!

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