ED Coding and Reimbursement Alert

Question: I’m familiar with the incision and drainage (I&D) codes, but I don’t think I should use 10060 when the ED provider evaluates an abscess that is starting to drain spontaneously, and they just add some additional skin pressure but don’t make any type of incision. Is there a better code for this?

Rhode Island Subscriber

Answer: Among I&D codes, you won’t find a specific code for this scenario. However, you’re right that 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single) is not appropriate in this case. Instead, you’d simply use an evaluation and management (E/M) service code.

When these services occur in the ED setting, you’ll choose a code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set.

The reason can be found in CPT^® Assistant (Volume 20: Issue 4), which explains that because the provider has not incised or aspirated the abscess, you should “report the appropriate E/M services based on the key components provided.” The actual E/M level depends on the provider’s medical decision making (MDM) level.