Orthopedic Coding Alert

Expert: Don’t confuse I&D with irrigation and debridement.

Orthopedic coders might not code as many incision and drainage (I&D) procedures as some other practices, but I&D knowledge needs to be part of your coding arsenal — because I&Ds happen.

Check out this Q&A with Denise Paige, CPC, COSC, an orthopedic coder with Bright Health Physicians in Whittier, California and stay ready for that next I&D claim.

Q: When might an orthopedist perform an I&D on a patient?

A: “An I&D is usually done for a superficial localized abscess or cellulitis. This could be due to a recent or old injury, a complication from surgery or an injury with a retained foreign body.  

“It’s important to understand the difference of incision and drainage versus irrigation and debridement codes 11042 [Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less] through +11047 [Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)].

“Just a physician listing the procedure as an I&D could have different meanings, so the documentation must support the correct choice of codes.”

Q: When would an orthopedist perform a single/simple I&D (10060)?

“[The I&D] could be done on a patient with a localized abscess or cyst — carbuncle, furuncle, paronychia, etc. — requiring a simple incision and drainage. The patient could have symptoms of localized pain, swelling, redness, or warmth in the area sometimes with the area of concern slightly raised or fluid filled.”

Q: When would an orthopedist perform a complicated/multiple I&D (10061)?

“[Complicated/multiple I&Ds] are for more complex or multiple cysts or abscesses that may require surgical closure at a later date. In order to choose the correct procedure code, the documentation should indicate either a simple or more complex procedure. Both codes, 10060 and 10061, have a 10-day global period.”

Q: What about incision and removal of foreign body (10120, 10121)? When, if ever, might the orthopedist perform one of these procedures?

“Removal of a foreign body is usually done after an injury where a very small portion of an object, metal or organic material, is left in the wound. Usually the wound is healed and the foreign body is discovered at a later date due to continue symptoms or pain, swelling, etc.

“Documentation should indicate whether the removal is simple or complicated indicating either a simple incision overlying the area with retrieval of the object with hemostats or forceps. A more complicated removal would require dissection of underlying tissues.

“Both codes, 10120 [Incision and removal of foreign body, subcutaneous tissues; simple] and 10121 [… complicated], have a 10-day global period.”

“It should be noted that a separate codes exists for foreign body removal in the foot: 28190 [Removal of foreign body, foot; subcutaneous], 28192 [… deep], and 28193 [… complicated].

[Editor’s note: According to CPT^® Assistant, 28192 and 28193 require a subfascial incision.]