ED Coding and Reimbursement Alert

Question: A Medicare patient reports to the ED for drainage of a simple finger abscess. The physician performed the drainage and sent the patient home. The patient reports back to the ED for a wound check. Notes for this second encounter indicate that the physician examined and then redrained the wound, changed the dressing and sent the patient home. Can we report this second E/M and the abscess drainage?

Oregon Subscriber

Answer:  It depends on when the wound check occurred. By Medicare rules, finger abscess drainages have a global period of 10 days. So if the patient reports back in 10 days or less, the wound check is bundled into the drainage. On the claim, report 26010 (Drainage of finger abscess; simple) for the encounter.

If, however, the patient reports for a wound check 15 days after the drainage, for instance, you can report the E/M and the drainage.

On the claim:

- report 26010 for the drainage

- report 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 the physician's wound check.