ED Coding and Reimbursement Alert

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.