ED Coding and Reimbursement Alert

Multiple I&D will mean 10061.

Failure to separate I&D by type could result in upcoding or downcoding — and both are big red flags in payers’ eyes.

Stay compliant and code right every time with this I&D primer.

Use 10060 for Simple/Single I&D

When the ED provider performs an I&D, it is typically for “a superficial localized abscess or cellulitis. This could be due to a recent or old injury, a complication from surgery or an injury with a retained foreign body,” explains Cathy Satkus, CPC, COBGC, of Harvard Family Physicians in Tulsa, Oklahoma.

The first type of I&D is simple/single, which you’d report with 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single).

“To bill simple, I look for a single I&D and/or one that required a low level of difficulty,” Satkus explains.

A simple/single I&D “could be done on a patient with a localized abscess or cyst — carbuncle, furuncle, paronychia, etc. — requiring a simple incision and drainage,” explains Denise Paige, CPC, COSC, coder with PIH Health Physicians in Whittier, California. “The patient could have symptoms of localized pain, swelling, redness, and warmth in the area; sometimes, the area of concern [is] slightly raised or fluid-filled.”

Example: A patient presents with an epidermal cyst on their left arm; the cyst is draining pus. The area was prepped with alcohol, and adequate anesthesia was obtained. The cyst was incised using a #11 blade. Approximately 1 cc of white fluid was expressed. Specimen sent for culture. The patient tolerated the procedure well without any complications and left the office in good condition.

For this claim, Satkus says you should report 10060 with L72.0 (Epidermal cyst) appended to represent the cyst.

Opt for 10061 for Complicated I&D

The second type of I&D is complicated/multiple. When your provider performs a complicated/multiple I&D, report 10061 (… complicated or multiple).

“To bill complicated I look for notes indicating multiple I&Ds or packing or drain placed,” says Satkus. “However, just because packing is placed doesn’t automatically make it complicated. The key is going to be the level of difficulty documented by the physician.”

Paige echoes the sentiment that coders shouldn’t try to decide whether an I&D is simple or complicated. That decision must be made by the performing provider. “In order to choose the correct procedure code the documentation should indicate either a simple or more complex procedure,” she says.

Example: A patient presents with complaints of painful bump on their right leg, right buttock, and left groin. Appropriate past family social history (PFSH) and review of systems (ROS) were documented. The patient noticed the bumps last night. The bumps are painful to touch and the leg area was draining this morning. They placed a warm compress on it last night with no change in appearance.

The ED physician finds a large subcutaneous abscess on the patient’s right leg that is draining pus. The right buttock and left groin each have an area of bumps that are painful to when touched; both are draining pus.

The ED physician preps the right leg abscess and anesthesia is injected. The incise the abscess with a #11 blade and drains large amounts of pus. The abscess continued to drain after 3cc of fluid were collected, so the provider packed the area with gauze.

Attention then turned to the right buttock, where the physician made an incision with a #11 blade; 1cc of fluid was collected.