EM Coding Alert

Question: I have a question regarding whether to apply both the E/M code and the procedure code for a service an emergency department (ED) physician provided. The documentation records that a father brought his son in for a swollen finger with pus draining from where it had been punctured. The physician performed an examination, which revealed swelling along the radial aspect of the right index fingernail fold into the base of the nail. The volar pad was soft, with no swelling or inflammation proximal to the distal interphalangeal (DIP) joint. The physician also examined the rest of the right hand and arm for signs of spreading infection.

The ED physician prepped the finger and made a 7mm incision to drain the pus. She then irrigated the wound, and drained a small amount of pus was from the wound with a 5 mm tab of iodoform. The physician did not remove the nail, but she did start the patient on antibiotics.

Should I apply both 99282-25 and 10060 to this claim, or should I only report the 10060 since the exam pertained only to the finger?

Alabama Subscriber

Answer: You should code the straightforward drainage of the paronychia with 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single).

In this case, the physician also treated a large collection of pus located at the nail fold that required a 7mm incision and some packing; usually a paronychia would require no more than a few millimeters of incision and no packing.

Therefore, one could also make the argument that this was not “simple” and that 10061 (… complicated or multiple) would apply. The documentation of the procedure will lead you to one of these codes.

With regard to the addition of an E/M code, most coders would feel comfortable submitting an E/M code if the documentation mentioned additional exam components, or screening for advancing or systemic infection.

In this particular case, the emergency physician separately examined the finger and arm for signs of lymphangitis, cellulitis or a tenosynovitis with perhaps even a consideration of an osteomyelitis above and beyond the drainage of the paronychia. She also wrote a prescription for antibiotics.

As long as the physician documented all these findings, you could consider an E/M service with a 25 modifier ((Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) in addition to the procedure code.