ED Coding and Reimbursement Alert

Question: The ED physician performs a level-four E/M service for a patient and diagnoses a peritonsillar abscess. Notes indicate that the physician aspirates the abscess to confirm the presence of pus, and then incises and drains it. Is this a 10060 incision and drainage (I&D)? Minnesota Subscriber Answer: These types of abscesses have their own I&D codes. For this encounter you would report the following codes: • 42700 (Incision and drainage abscess; peritonsillar) for the I&D • 99284 (Emergency department visit for the evaluation and management of a patient, which requiresthese 3 key components: detailed history; a detailed examination; and medical decision making of moderate complexity ...) for the E/M • modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99284 to show that the E/M and aspiration were separate services • 475 (Peritonsillar [...]