Internal Medicine Coding Alert

How do you get paid for repeat procedures within global period?

When your clinician performs an incision and drainage (I&D) of an abscess, you must know whether to report a simple code or a complicated code. You should also look at the anatomical location of the abscess as this will impact your code choice for reporting the I&D as well.

Read the following four scenarios and see if you can crack the coding for the different incision and drainage situations elaborated.

Scenario 1: Simple vs. Complicated I&D

Your internist reviews an 18-year-old male patient with complaints of acute pain and tenderness in the heel of the left foot. The patient complained that he got an injury four days before when he stepped on a nail that had fallen on the ground. Upon examination, your internist finds that the area is inflamed, tender, and infected with pus. Using a No.11 scalpel, your internist makes an incision and drains the pus from the wound. Your clinician then irrigates the wound and places a dressing.

What code would you use to report the procedure that your internist performed?  

        1) 10060
     2) 10061
     3) 10120
     4) 10121

Scenario 2: Anatomical Site-Specific I&D Reporting

Your internist reviews a 29-year-old female patient with complaints of acute pain and tenderness in the area of the wrist. Upon examination, your clinician finds that the area is severely inflamed and is tender.

Your clinician diagnoses the patient with a deep abscess not involving the bursa, and he performs an incision to drain the abscess, performs extensive probing to break down loculations, and then cleans and irrigates the wound along with placing sutures and dressings.

What code would you use to report the procedure that your internist performed?  

        1) 10060
     2) 10061
     3) 25028
     4) 25031

Scenario 3: Multiple Abscess I&D Reporting

Your clinician reviews a 16-year-old male patient who had injuries from a shard of glass about three days ago. The patient said that the injuries were very superficial and that he had just bruises on his upper arm and chest area at that time, so he did not seek any medical attention then. He slowly started developing redness over the area of the injuries along with severe pain and tenderness on the upper arm. Your clinician examined the upper arm and determined that the area was inflamed and infected. He also noticed some amount of infection in the chest wound. He performed incisions on both the areas and drained the pus from the wounds. In the upper arm area, he probed extensively to break down loculations. No glass particles were found in either of the wounds.

What code(s) would you use to report the procedure that your internist performed?

        1) 10060
     2) 10061
     3) 10060, 10060-59
     4) 10061, 10060-59

Scenario 4: Repeat Procedure Within Global

Your internist performed an incision and drainage of an abscess of a wound in the area of the thigh. You reported 10060 for the procedure performed. A week later, the patient returned with pain and tenderness in the area. Your clinician determined that the area was again infected and performed a repeat incision and drainage of the wound. Your clinician then irrigated the wound and placed a dressing.

What code(s) would you use to report the procedure that your internist performed during the second encounter?

        1) 10060
     2) 10061
     3) 10060-76
     4) 10061-76  

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