ED Coding and Reimbursement Alert

Question: The emergency department physician had performed an incision and drainage procedure on a patient who returned to the ED two days later. At this visit, the physician reopened the abscess, irrigated it, and replaced the wick. Is this a billable service?

Washington, D.C., Subscriber Answer: Yes, you can bill this service using an evaluation and management code (99281-99285). Usually, CPT bundles typical postoperative care - and the plain and simple removal of packing would constitute typical postoperative care. However, if the abscess requires additional work, such as repeat drainage, dissection, irrigation, or replacement of packing, then you have most likely surpassed what the physician would typically perform.

Remember: Medicare, using the global period concept, generally bundles all additional work related to the initial procedure unless it requires a trip back to the operating room.