Pediatric Coding Alert

Be ready with 10061 for complicated, multiple I&Ds.

Pediatricians performing incision and drainage (I&D) services for a patient present the coder with a challenge, but all of the answers you need should be in the encounter notes.

The basics: There are two types of I&D; there are codes for specific I&Ds that stray from the typical I&D service, but most of your pediatrician’s I&Ds will be pretty straightforward.

Read on for all the information you’ll need to code these I&Ds correctly.

Superficial Drainage = 10060

When the pediatrician identifies a simple single abscess and performs I&D, you’ll report the service with 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single).

Definition: “A simple or single abscess is limited to a small collection of purulent material, such as a paronychia, a small cyst, or the type of pus collection generally found around an infected hair follicle,” explains Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, CEO of Edelberg + Associates inBaton Rouge, La.

Consider this example from Cathy Satkus, CPC, coder at Harvard Family Physicians in Tulsa, Okla.:

An 11-year-old established patient presents to the pediatrician for a sore on her left arm. The patient says that the sore is “leaking,” and has been for about a day. The patient’s mother reports that the sore appeared three or four days ago, and has gotten bigger since then.

The provider examines the area around the sore, preps the area with alcohol andadministers adequate anesthesia. Using a No. 11 scalpel, the provider removes about 1 cc of white fluid from the sore and sends the sample off for culture testing. The patient tolerated the procedure well, and left the practice in good condition.

On this claim, you’d report:

• 10060 for the I&D
• 87040 (Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates [includes anaerobic culture, if appropriate]) for the culture
• L72.0 (Epidermal cyst) appended to 10060 and 87040 to represent the patient’s cyst.

Complicated I&D Could Include Packing

While most I&Ds performed by a pediatric practice are 10060 services, there are also instances in which you might need to use 10061 (… complicated or multiple).

As the descriptor indicates, you’ll use 10061 for complicated or multiple I&Ds; so, if notes indicate that the provider performed three I&Ds on the same patient during the same encounter, you’d report 10061.

It’s simple enough to identify multiple I&Ds, but things get muddy quick when trying to pin down a definition of “complicated,” for coding purposes. “The more complicated abscesses are larger and may require probing to break up loculations; they also generally require packing,” explains Edelberg.

Also:  Complicated abscesses might occasionally “require sonography to identify the extent of the lesion, particularly when a significant MRSA [Methicillin-resistant Staphylococcus] infection is suspected,” reports Edelberg. A 10061 I&D could also include probing to break up loculations and packing with gauze to keep the wound open for healing, she continues. This type of service is rare in a pediatric office; however, a pediatrician could perform 10061.

Satkus takes the same approach to complicated I&D coding. “I look for notes indicating multiple I&D or packing or drain placement,” she says. That might not be enough info to justify 10061. Packing or other interventions could make the I&D complicated, but these actions “don’t automatically make [the I&D] complicated. The key is going to be the level of difficulty documented by the physician,” she says.

That’s right: According to the December 2006 CPT^® Assistant, simple versus complicated I&D is at the physician’s discretion based on the level of difficulty, Satkus confirms.

Best bet: Learn the typical differences between 10060 and 10061 coding scenarios, so you can spot potential 10061 encounters. You might also want to confer with your providers to remind them that complicated I&D is often in the eye of the beholder — and discussing what each provider considers complicated could go a long way toward simplifying your coding.