ED Coding and Reimbursement Alert

Question: Our ED provider saw a 29-year-old female patient with complaints of acute pain and tenderness in the area of the wrist. Upon examination, the physician found that the area was severely inflamed and tender. The doctor diagnosed the patient with a deep abscess not involving the bursa, and performed an incision to drain the abscess, along with extensive probing to break down loculations, and then cleaned and irrigated the wound along with placing sutures and dressings. Which codes apply to this situation?

Washington Subscriber

Answer: In this scenario, report 25028 (Incision and drainage, forearm and/or wrist; deep abscess or hematoma) for the incision and drainage (I&D) procedure that your clinician performed.

CPT^® codes 10060 and 10061 are not the only codes that you have to report an incision and drainage of an abscess. CPT^® also has some site-specific codes that you can report when your clinician performs an I&D of an abscess that is located in these specified sites. CPT^® guidelines instruct you to report these site-specific codes (when available) instead of reporting 10060 or 10061.

There are two site-specific codes that you can choose from when your clinician performs an I&D in the wrist:

• 25028
• 25031 (…bursa)

Report 25031 when your clinician performs an I&D of the bursa. Since in the case scenario described, your clinician performed an I&D of an abscess deep in the wrist and not an I&D of an infection of the bursa, you should report 25028 and not 25031.

The site-specific codes are not often used by emergency physicians, but if they accurately describe the service provided, the assigned relative value units (RVUs) are significantly higher than the nonspecific I&D codes: