ED Coding and Reimbursement Alert

Question: A patient with a plan of care in place for her type II diabetes reports to the ED complaining of a painful left index finger. She says the digit has been red and swollen for the past three days, and she rates the pain a 6 on a 10-point scale. The non-physician practitioner (NPP) provides a level-three E/M service, during which he notes “fluctuance limited to area surrounding lateral nail fold. Final Dx: Paronychia” Using a scalpel, the NPP performs incision and drainage (I&D), flushes the area with saline and dresses the wound. Does this qualify as an I&D for coding purposes?

Minnesota Subscriber

Answer: Since the NPP used a scalpel and irrigation to treat paronychia, this qualifies as an I&D. On the claim, report the following:

• 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) for the I&D

• the appropriate-level ED E/M code based on encounter notes (99281-99285, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: …)

• 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 the E/M code to show that it was a separate service from the I&D

• 681.02 (Cellulitis and abscess of finger and toe; Onychia and paronychia of finger) appended to 10060 and the E/M to represent the patient’s injury.

For ICD-10, use L03.012 (Cellulitis of left finger)

Note: If the NPP has to consider the patient’s diabetes during the course of treatment, append 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) to 10060 and 99283 as a secondary diagnosis. If the patient’s diabetes is not an issue during the procedure, don’t list 250.00.

Consider your scenario: If the NPP had to take the patient’s insulin intake into account while prescribing antibiotics to prevent infection, you’d include 250.00 as a secondary diagnosis.