# Incision and drainage coding help



## KimKrebs (Dec 4, 2017)

I am trying to figure out if I can use a procedure code for I & D, or if this would be considered part of the E/M service. 

"left forearm with 1 cm round nodule with central black coloring. Under sterile technique the area was explored with 22 gauge needle, no foreign body found, pus and blood drained and culture obtained"

Maybe there is a different code that better describes this procedure. This is a pediatric patient and not something we commonly code. Any help would be appreciated.

Thank you!


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## ellzeycoding (Dec 5, 2017)

Use CPT 10140 - Incision & drainage of hematoma, seroma or fluid collection


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## CatchTheWind (Dec 12, 2017)

Doesn't that code (and all the I&D codes) require use of a blade?


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## ellzeycoding (Dec 12, 2017)

I&D are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected perinasal sinus. It is performed by treating the area with an antiseptic, such as iodine-based solution, and then making a small incision to puncture the skin using a sterile instrument such as a* sharp needle, a pointed scalpel or a lancet*. This allows the pus fluid to escape by draining out through the incision. The surgical wound is left open to allow for continued drainage.


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## ny2scgirl (Dec 13, 2017)

Could CPT 10060 be used? What is the difference between CPT 10060 and 10140?


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## m.edwards (Dec 18, 2017)

I would recommend looking at codes for puncture aspiration of a cyst, such as 10160.  It is also not recommended to assume a diagnosis by the quality of the substance aspirated.  Be sure to code based on the diagnosis given by the physician.  CPT 10160 does include puncture aspiration of an abscess, hematoma, bulla, or cyst.


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## CatchTheWind (Dec 22, 2017)

10160 requires aspiration.  If the fluid was just drained you have to use one of the I&D codes.


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## KimKrebs (Dec 30, 2017)

Thank you!


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## kristinn0104 (Aug 13, 2021)

ellzeycoding said:


> I&D are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected perinasal sinus. It is performed by treating the area with an antiseptic, such as iodine-based solution, and then making a small incision to puncture the skin using a sterile instrument such as a* sharp needle, a pointed scalpel or a lancet*. This allows the pus fluid to escape by draining out through the incision. The surgical wound is left open to allow for continued drainage.


Where can I find this definition?

Thanks,
Kristin


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## carlystur (Aug 16, 2021)

kristinn0104 said:


> Where can I find this definition?
> 
> Thanks,
> Kristin


You can find a lot of helpful information on the Merck Manuals site.


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## kristinn0104 (Aug 19, 2021)

@carlystur Thank you!


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