Orthopedic Coding Alert

Question: For a patient who reported back to the ED for a wound check following drainage of the simple abscess in his index finger of the right hand, our surgeon examined the wound and decided to drain it again. How do we report this repeat drainage?

New York Subscriber

Answer: Since this is a repeat drainage, you need to know when after the first drainage the patient reported to the ED. There is a global period of 10 days for drainage of a finger abscess. “The global period for 26011 (Drainage of finger abscess; complicated [eg, felon]) is 10 days. Repeat I&D within this period by your surgeon would require use of the 58 (Staged or Related Procedure or Service by the Same Physician during the Postoperative Period) modifier.

If the patient reports to the ED within 10 days after the first time the finger abscess was drained, then you only report 26010 (Drainage of finger abscess; simple). The wound check here is bundled into the drainage. However, if this being performed within the 10 day global period, you will need to append modifier 58 (Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional during the Postoperative Period).

However, if the patient returned to the ED beyond 10 days, you report 26010 for the drainage and 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) for the wound check.