ED Coding and Reimbursement Alert

Question: The ED physician performs incision and drainage on a patient's forearm carbuncle. Four days later, the patient returns with a severe headache and neck pain. The physician examines the patient consistent with a level-four service and sends him home. Can I report both of these services, or is the second visit considered part of the global surgical package?


Michigan Subscriber



Answer: You-ll be able to report the second service with an E/M code because the E/M visit was for a problem unrelated to the earlier incision and drainage. Because the second visit occurred within the global period of the incision and drainage (10 days), some payers will want you to include modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).

On the first visit claim, you should:

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

- link 680.3 (Carbuncle and furuncle; upper arm and forearm) to 10060 to represent the patient's carbuncle.

- report the appropriate-level E/M code for the second visit based on the physician's notes.

- link 784.0 (Headache) to the E/M code to represent the patient's headache.

- link 723.1 (Cervicalgia) to the E/M code to represent the patient's neck pain.

- attach modifier 24 to the E/M code to show that the E/M was unrelated to the incision and drainage.