ED Coding and Reimbursement Alert

Question: Would you clarify the difference between a simple and complex incision and drainage (CPT codes 10060 and 10061)? We have read the Coding Clinic guidelines and the Coders Desk Reference for Procedures and are under the impression that the difference in the procedures is determined by whether or not the clinician uses packing after the incision. Is this correct?

Alaska Subscriber

Answer: Your assumption may be correct in some cases, but not in others. The description for code 10060 (Incision and drainage of abscess; simple or single), includes clinical examples of a carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, paronychia, cyst, or furuncle. These are all simple, single, isolated small collections and rarely (but occasionally) require packing.
 
The more complex lesions (10061, ... complicated or multiple), on the other hand, will generally be larger. These lesions may require packing, probing to break up loculations, or may be a collection of more than one simple area. Any of these factors should indicate that the lesion(s) warrants 10061.