Otolaryngology Coding Alert

Question: What codes should be used for incision and drainage (I&D) and needle aspiration of a parotid abscess?

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Answer: CPT lists two codes for I&D of a parotid abscess 42300 (drainage of abscess; parotid, simple) and 42305 (... parotid, complicated). The simple procedure is coded if performed at the patients bedside or in the office. If the patient is taken to the operating room, 42305 should be used, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPTs editorial panel and executive committee.

Although the descriptor of both codes indicates drainage only, not incision, they appear under the Incision subsection of the Salivary Glands and Ducts portion of CPT, points out Randa Blackwell, a coding and reimbursement specialist with the department of otolaryngology at the University of Maryland in Baltimore. Therefore, incision is clearly a part of the procedure.

As for the needle aspiration of a parotid abscess, Blackwell says she would use the same codes but with modifier -22 (unusual procedural services). Although most coders associate use of modifier -22 with claims for additional payment, this need not always be the case. In this situation, the modifier would let the carrier know that the procedure was not typical without asking for additional reimbursement.

Using modifier -22 in this way, Blackwell says, allows the coder to stay in the same section of the CPT book, using the salivary glands set of codes instead of integumentary codes such as 10160 (puncture aspiration of abscess, hematoma, bulla, or cyst). She notes that 42300 and 42305 more accurately describe where the procedure took place which, in her opinion, provides more accurate coding. Furthermore, these codes reimburse at a higher rate than 10160.

Note: Some carriers routinely deny claims with modifier -22 attached, Eisenberg says, adding that 42300 and 42305 may also be submitted on their own for a needle aspiration without the modifier.