# I&D vs Puncture Aspiration



## rjgoetz (May 23, 2014)

The physician punctured a ganglion cyst with a needle and then squeezed the gel like fluid from the cyst.  She did not aspirate it with the needle, and she did not make an incision.  I cannot find any other code for what she did, so which one of these is more accurate??  I am thinking 10160.  Need help/opinions please.


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## mitchellde (May 23, 2014)

It appears this may just be part of the E&M and not billable s a procedure.


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## mbucknam (May 23, 2014)

*Ganglion Cyst*

I respectfully disagree with bundling this into the E/M service. This procedure is no part of history, exam or decision making. 

However, I would say that you're in the wrong part of the book. Gangion cyst treatments are found in the musculoskeletal system. Consider whether code 20612 seems appropriate. This code includes both aspiration and injection so it is not necessary to aspirate through the needle to use the code.

And if you don't mind me getting on my soapbox for a moment, I think this is one of the most common mistakes people make. They try to use skin lesion codes for treatment of conditions that are not skin lesions. In this case, you can use the CPT Index and look up ganglion cyst and it takes you right to 20612. Reimbursement is also usually better for these non-skin codes.


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## mitchellde (May 23, 2014)

20612 is not descriptive of what is posted.  20612 requires a local anesthetic and the insertion of a needle to withdraw fluid.  This is not the same as using pressure to express fluid.  There is no procedure code that comes close and as no anaesthetic is used it is a part of the E&M just as most minor treatments are. This is no different that popping a pimple.


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## rjgoetz (May 23, 2014)

Incision  Needle 18 gauge.  
       Drainage  clear yellow gel.  
       wound explored  Contents expressed.  
       Anesthesia  1% lidocaine w/epi.  
       Pre procedure Diagnosis  cyst.  
       Post procedure Diagnosis  same.  
       Location  left wrist.  
This is how she documented the procedure. I spoke with her and clarified that she did indeed squeeze and not aspirate.  BUT she did poke it with a needle first.


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## rjgoetz (May 23, 2014)

Anesthesia 1% lidocaine w/epi. was used.


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## mitchellde (May 23, 2014)

It still does,not meet the definition of an I&D or an aspiration procedure.


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## rjgoetz (May 23, 2014)

Ok. Thanks for your help.


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## JesseL (Oct 31, 2014)

What about 10040? In terms of puncturing a cyst with a needle.

It says opening or removal on the code description

10040 "acne surgery (eg, marsupialization, opening or removal of multiple milia, comdones, cyst, pustules)


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