ED Coding and Reimbursement Alert

Reader Question:

Aspiration Becomes Drainage

Question: A patient presented to the ED with a peritonsillar abscess (PTA) and underwent a needle aspiration to confirm the presence of pus in the tissues. During this procedure, the physician determined that the abscess could be drained completely with the needle aspiration. He subsequently used an 18-gauge spinal needle and aspirated the pus with a 10-cc syringe. When attempting to bill for this, I noticed that the only codes addressing a PTA involve "incision and drainage." What code is best used to bill an aspiration without an incision?

California Subscriber  
Answer: Code 42700 (incision and drainage abscess; peritonsillar), 42720 ( retropharyngeal or parapharyngeal, intraoral approach) and 42725 ( external approach) are indeed specific to cases of PTA. However, as all procedures should be coded to the highest level of specificity, the situation you describe should be coded with 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]).
 
In fact, needle aspiration is a definitive drainage procedure for PTA. Aspiration can also be used to confirm the presence of pus prior to incision and drainage, as was the first step in your question.
 
Make sure you also bill for any anesthetic used, and include the diagnosis code for PTA, 475.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

ED Coding and Reimbursement Alert

View All