ED Coding and Reimbursement Alert

Question: A patient with a simple pilonidal cyst reports to the ED. The ED physician decides to incise and drain infected abscess material from the cyst before performing a more formal excision. The physician provided both services during the same visit. Can we code the I&D separately?

Georgia Subscriber

Answer: You can't report the incision and drainage (I&D) separately in this instance.

Explanation: CMS guidelines set forth in the Correct Coding Initiative (CCI) state, "In cases where, in the course of an excision of a lesion, an area of involvement is identified which requires drainage, either as a part of the procedure or to gain access to the area of interest, coding/billing for incision and drainage of this fluid collection would be inappropriate if the excision or other procedure is performed in the same session."

Result: You should leave 10080 (Incision and drainage of pilonidal cyst; simple) off of the claim.

Report 11770 (Excision of pilonidal cyst or sinus; simple) for the procedure. Don't forget to append ICD-9 code 685.0 (Pilonidal cyst; with abscess) to 11770 to prove medical necessity for the service.