Otolaryngology Coding Alert

Question: An otolaryngologist performs the following inpatient procedures:
  incision and drainage (I&D) of a deep abscess of the neck (21501) on days 1 and 3.
  packing change (15852) on days 4 and 5. Should I include the packing removal as part of 21501?


New Jersey Subscriber


Answer: No. You may separately report the dressing change with 15852 (Dressing change [for other than burns] under anesthesia [other than local]). The National Correct Coding Initiative does not bundle 15852 and 21501 (Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax). Code 15852 is not typical follow-up care. The surgeon places the patient under conscious sedation or general anesthesia to change the packing.

Your ICD-9 coding should demonstrate that the procedures are separate. Use the abscess diagnosis (for instance 682.1, Neck cellulitis and abscess) for the I&Ds (21501). Link the packing changes (15852) to the open wound code (such as 874.10, Open wound of larynx with trachea, complicated).

Remember: Code 21501 has a 90-day global surgical period. Therefore, you will need a postoperative period modifier on the subsequent procedures to indicate their relationship to the I&Ds' global periods.

Look carefully at your otolaryngologist's I&D documentation. If she notes that if the initial I&D doesn't work, she will perform another I&D, you can justify modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) on the second I&D. But if the otolaryngologist doesn't indicate she planned the second I&D and she performs the procedure in the operating room - rather than at the patient's bedside - you would append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to day three's I&D: 21501-78.

The patient probably required the packing changes due to a complication or infection. Thus, you would append modifier -78 to day four and five's 15852. If the otolaryngologist planned the dressing changes prior to day four, you should instead use modifier -58 on 15852.

If a payer denies the dressing charges (15852), you may challenge the decision. Inform the insurer that the majority of I&D patients do not require dressing changes. Therefore, 21501 should not include 15852.