Pediatric Coding Alert

Question: I’m familiar with the incision and drainage (I&D) codes, but I don’t think I should use 10060 for when the pediatrician just punctures an abscess and it drains by itself. Is there a better code for this?

Delaware Subscriber

Answer: Among I&D codes, you won’t find a specific code for this scenario. However, you’re right that 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single) is not appropriate in this case. Instead, you’d simply use an evaluation and management (E/M) service code.

The reason can be found in CPT^® Assistant (Volume 20: Issue 4), which explains that because the pediatrician has not incised or aspirated the abscess, you should “report the appropriate E/M services based on the key components provided.” Because the problem seems to be self-limited with minimal risk, it’s likely that the scenario you outlined wouldn’t require a higher level than 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/ or examination and straightforward medical decision making ...) assuming your patient is established to your practice. However, the actual E/M level depends on the practitioner’s documentation along with their medical decision making (MDM) or length of time spent.