ED Coding and Reimbursement Alert

Question: A patient presents to the ED with a swollen growth on her left thigh; she reports that it has increased in size over the past week and is "leaking pus." During the examination, the patient says that the growth has been present for "about two months" and she rates the pain as 7 on a scale of 10. After a level three ED E/M service, the ED physician decides to perform incision and drainage (I&D) on the wound. Initial attempts to drain the wound with a scalpel prove unsuccessful, so the physician makes several tiny incisions at strategic spots on the wound to facilitate drainage. After letting the wound drain for 10 minutes, the physician installs a drain to remove the remaining pus. He then packs the wound to minimize the bleeding. The ED E/M takes 15 minutes, and the I&D takes 27 minutes. Can I code 10061 for the I&D?

Massachusetts Subscriber

Answer: Your scenario meets the requirements for a complicated I&D. On the claim, report the following:

10061 (Incision and drainage of abscess [e.g. carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple) for the I&D

99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M service

Modifier 25 appended to 99283 to show that the E/M and I&D were separate services [10061 is a 10 day global period code]

682.6 (Other cellulitis and abscess; leg, except foot) appended to 10061 and 99283 to represent the patient's injury.

The lowdown: In addition to the primary service, a simple I&D (10060 [... simple or single]) may be limited to a single lesion (e.g., a paronycia or furuncle require packing to minimize bleeding). Complicated I&Ds are more involved, however.

You can often code 10061 when notes indicate:

• The physician made multiple incisions to drain the wound
• The physician drains multiple growths in the same area
• The abscess is complicated by the presence of an infection
• The physician an unusual length of time to perform the I&D
• The I&D is unusually deep
• The wound requires more post-op care, such as drain placement, or packing

Best bet: Code with caution, but be on the lookout for 10061 opportunities when notes indicate that the I&D involved any of the above characteristics.