ED Coding and Reimbursement Alert

Depth, not size, often marks more complex procedure When patients report to your ED for incision and drainage (I&D) of abscesses, you should be on the lookout for evidence of a complicated I&D, as this procedure pays an average of $72 more than a simple I&D. But don't go coding a complicated I&D without proof that the ED physician performed one, or you will land in hot water with payers. Read on for this advice on reporting different types of I&Ds. Single Incision Usually Enough for Simple I&D Your ED physician will often perform superficial (or simple) I&Ds, confirms Robert LaFleur, MD, FACEP, of Medical Management Specialists in Grand Rapids, Mich. You will typically use 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single). "A superficial abscess will usually be right at the skin surface and will require a single incision to drain it," he says. In a nutshell: A simple I&D "is an incision of an abscess, cyst, carbuncle, suppurative hidradenitis, cyst, furuncle, or paronychia that is situated just below the skin's surface or subcutaneously," explains Yvonne P. Mayer, CPC, senior coding analyst at Bill Dunbar and Associates LLC in Indianapolis. Check Out 10060 Case One common example of a superficial I&D is a patient with folliculitis (704.09, 704.8), says one coding specialist at a Kentucky ED. "The area is red, the skin is swollen and painful to the touch and has a whitehead," she explains. "While there is no size that indicates that an abscess is superficial, they are usually somewhat small and easy to incise; the pus inside is not coagulated, and it is removed easily with a small amount of irrigation," she explains. Example: A patient reports to the ED with a bite mark on his right arm; he says "some kind of bug" bit him three days ago, and now the bite area is red, hot, and tender. A level-two E/M reveals a quarter-sized induration with a central pustule on the forearm, but no epitrochlear or axillary adenopathy. The ED physician diagnoses a 2-cm superficial abscess, makes a single incision with a No. 11 blade, and expresses pus from the wound; he then cleans and dresses the wound area. The patient is instructed to return to the ED for a wound check in one to two days. This is an example of a simple I&D, confirms LaFleur. On the claim, report the following: - 10060 for the I&D - 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of low complexity) for [...]