Pediatric Coding Alert

Question: What’s the difference between simple/single incision and drainage (I&D) and complicated/multiple?

North Carolina Subscriber

Answer: CPT^® has divided several I&D codes into pairs designated as either “simple or single” or “complicated or multiple”:

• 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single)
• 10061 (… complicated or multiple)
• 10080 (Incision and drainage of pilonidal cyst; simple)
• 10081 (… complicated)
• 10120 (Incision and removal of foreign body, subcutaneous tissues; simple)
• 10121 (… complicated)

While documentation should make it easy for you to determine if your pediatrician performed one or multiple procedures, from a coding perspective, the definition of simple and complicated is not so clear. The CPT^® book does not provide definitions for the terms; instead, you should look to guidance found in CPT^® Assistant if you are faced with a choice between codes.

Per a Q&A that appeared in the December 2006 issue of CPT^® Assistant [Volume 16: Issue 12], CPT^® does not define ‘simple’ or ‘complex’ in this context. Instead, CPT^® Assistant says, ‘the choice of code is at the physician’s discretion, based on the level of difficulty involved in the incision and drainage procedure.”