Otolaryngology Coding Alert
Report 42700 with Modifier 52 for Failed Drainage
Question: We had a patient come in for a peritonsillar abscess. The physician performed an incision and drainage (I&D), but the procedure produced no pus or fluid. Does this still qualify as an I&D, or should I submit this as an evaluation and management (E/M) visit (99214)? Alabama Subscriber Answer: As you are already aware, when the physician performs an I&D, you may not report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; …) alongside 42700 (Incision and drainage abscess; peritonsillar), due to a National Correct Coding Initiative (NCCI, or CCI) bundling edit. Despite the fact that the procedure produced no pus or fluid, you should still report 42700. However, you’ll want to append modifier 52 (Reduced Services) since the procedure did not complete the drainage process. When you report a service with modifier 52, make sure to submit the claim on paper (and electronically, for timely filing). On the paper claim, you’ll want to include a copy of the operative report and a thorough explanation as to why the service was not fully rendered.
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Report 42700 with Modifier 52 for Failed Drainage
Question: We had a patient come in for a peritonsillar abscess. The physician performed an [...]
