General Surgery Coding Alert

Question: If I use procedure code 10060* (incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single), can I bill Medicare for an office visit too if they are both performed on the same day?

Noelle Wikon
Office of Peter Korda, MD, Rochester, MI

Answer: Code 10060 is a starred (*) procedure, which the CPT book defines as a relatively small surgical service involving a readily identifiable surgical procedure but variable preoperative and postoperative services, including I&D of an abscess. However, the guidelines CPT set up for starred proceduresspecifically the use of code 99025 (initial [new patient] visit when starred (*) surgical procedure constitutes major service at that visit)are not observed by most carriers and have fallen into disuse. These procedures are coded much the same as similar, unstarred procedures, according to Arlene Morrow, CPC, CMM, a coding and reimbursement specialist in Tampa, FL.

Morrow says that if a Medicare patient receives I&D of an abscess (10060), but the physician has to deal with something in addition to the I&D (if it involved a second diagnosis), you can bill the office visit and the procedure, attaching modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code.

She notes that since April 1999, Medicares National Correct Coding Initiative has bundled E/M services with small procedures like these, so any E/M performed that resulted in the decision to perform the surgery may not be billable. Commercial carriers will pay for the E/M, however, if the exam prompted the procedure.

Morrow notes that many of the new software programs allow coders to add comments to the HCFA 1500 claim form and says that in many instances claims are being paid if the comments note that the visit led to the decision to perform the procedure. She recommends including documentation of the visit as well as separate documentation of the procedure, which should be on a separate page called Procedure Note.

Of course, if the procedure was preplanned and the physician performs minimal E/M, it should not be billed.

Code 10060 has a 10-day global period, so any pre- and postoperative care can be billed. Further, no other procedures are bundled into these codes. So if your physician performs multiple starred procedures, generally you can bill for all of them. These procedures are frequently bundled into major surgeries, so check the NCCI before billing a starred service in those circumstances.