ED Coding and Reimbursement Alert

Question: I frequently incise and drain abscesses, and wonder, from a billing point of view, what constitutes the difference between simple and complex drainage procedures. Also, what is the difference between incising a superficial abscess and I&D abscess? Finally, if I were to curette out a lesion like a spider bite, how should I code it? Is it the same as abscess even though the work is more intricate?

New Mexico Subscriber

Answer: 10060* (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) is a starred procedure limited to single, small collections of purulent material such as a paronychia, a small cyst, or pus collection around a hair follicle. Based on the examples in CPT, the infection would be limited to the superficial subcutaneous tissues and would be quite small.

Code 10061 (& complicated or multiple), a nonstarred procedure, is for more than one small superficial abscess or a single larger and/or more complicated abscess. The more complicated abscesses are larger and may require probing to break up loculations or packing. Curetting falls within the modalities used to treat abscesses in general. Spider bites tend to be larger, more complicated lesions and would likely fall under 10061.