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I & D CPT and Diagnosis

  1. #1
    Wink I & D CPT and Diagnosis
    Medical Coding Books
    Our PA did an I & D (code 10060) with a diagnosis Abscess of Finger (681.00). Medicare has denied for CO-11 inconsistent w/the procedure. I also tried the other codes we had (686.9 and 915.6), none of which has worked. Please help...

    Thank you
    Sincerely,

    Kristie Stokes, CPC, CPMA, CCS, CMDP, ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

  2. #2
    Default
    Could the problem be more of who performed the procedure? A PA instead of the doctor??
    adrianne, cpc

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I would call your carrier...we have recently had A LOT of inappropriate denials since our carrier changed. We have to fight with them DAILY!
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Default
    It's not who performed it because we bill under our physician, since she oversees the PA. I will call the carrier. Thank you for you help .
    Sincerely,

    Kristie Stokes, CPC, CPMA, CCS, CMDP, ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default cpt 26010
    Would CPT 26010 or 26011 fit the procedure that was documented?

    Encoder Pro lists the lay descriptions as follows:
    The physician drains an abscess located in a finger. In 26010, the physician lances an abscess located in the cutaneous tissue of a finger. In 26011, the abscess just reaches deep subcutaneous tissue and requires debridement and irrigation. The wound may be left open to drain.


    F Tessa Bartels, CPC, CPC-E/M

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