ED Coding and Reimbursement Alert

Question: A patient has an existing diagnosis of benign inflamed seborrheic keratosis in her cheek. The physician opens the site with an incision and drains pus from the wound, then removes the sebaceous material. He takes a biopsy and submits the specimen to pathology, and the lab agrees with the keratinous cyst diagnosis. Should I bill an excision in addition to an incision and drainage (I&D)?


Texas Subscriber

Answer: You should not report the excision. The physician either drains the whole cyst or excises it. She can't do both, because an excision would remove the whole cyst by definition, making drainage irrelevant.

Before filing the claim, ask the physician for a description of exactly what she did during the encounter.  Then select one of the following codes for your claim:

- choose 10060 (Incision and drainage of abscess  [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) if the physician performed a simple cyst drainage.

- choose 10061 (... complicated or multiple) if the physician performed a complicated drainage. Because the physician performed a biopsy and an I&D, you would probably pick 10061 for this claim.

Remember: While it may be tempting to code the biopsy separately with 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion), resist the temptation. The biopsy service is bundled into both 10060 and 10061.