Podiatry Coding & Billing Alert

Understanding when to use surgery codes will increase your practice’s payout.

Performing incision and drainage (I&D) procedures is a fundamental aspect of a podiatrist’s role. However, the frequent execution of these procedures does not necessarily guarantee their accurate reporting. Here are three myths you should bust to sharpen your I&D coding skills and help you avoid claim denials.

Myth 1: You can use an I&D code for a foreign body removal (FBR).

Answer: This is incorrect. If your podiatrist extracts a wooden splinter from a patient’s foot solely using a needle and tweezers, you should not report an I&D code “because the descriptors for 10120 [Incision and removal of foreign body, subcutaneous tissues; simple] and 10121 [… complicated] say, ‘Incision and removal of foreign body.’ But there is no incision if the provider is just using needle and forceps,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

In such cases, you may have to reach for an evaluation and management (E/M) code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/ established patient …) to accurately describe the service that your physician provided.

If your podiatrist does perform the incision part of a FBR, you can use 10120 or 10121, however. That’s because these codes “should always be used for superficial FBRs in the skin, hence the code numbers’ location in the integumentary section, while site-specific codes are for deeper FBRs below the skin level, which is why the codes are in the musculoskeletal section of CPT^®,” says Moore.

In such cases, you’ll turn to the surgery codes and use one of the following:

• 28190 (Removal of foreign body, foot; subcutaneous)
• 28192 (… deep)
• 28193 (… complicated)

Know the Difference Between I&D and Puncture Aspiration

Myth 2: You cannot use an I&D code for the extraction of fluid from a patient’s hematoma.

Answer: In most cases, this is not true. You could use an I&D code for this procedure. While it is possible to use 10140 (Incision and drainage of hematoma, seroma or fluid collection), a puncture aspiration code, 10160 (Puncture aspiration of abscess, hematoma, bulla, or cyst), might also work in this situation.

Which code you choose will depend on which method your provider uses. For example, “In an I&D of a hematoma, the physician incises the fluid pocket, bluntly penetrating it to aid fluid evacuation,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. “In addition, with this procedure, the physician may pack the incision or place a drain to let the fluid drain continuously,” Falbo adds.

On the other hand, puncture aspiration “typically involves the provider using a large bore needle on a syringe, aspirating the fluid into the syringe, and thus decompressing the fluid space,” Moore notes. In this procedure, “as 10160 simply involves needle aspiration, there is no closure, and a simple pressure dressing may be placed over the site when the procedure is complete,” says Moore.

Understand How to Code Bursa I&D

Myth 3: When your provider removes fluid from a patient’s bursa, you can you use 10060, 10061, or 10140.

Answer: This is not true. You would not use 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), or 10140 (Incision and drainage of hematoma, seroma or fluid collection) for this procedure.

This procedure involves the podiatrist performing an I&D below the cutaneous layer, which is why 10060, 10061, and 10140 don’t describe the deeper procedure involved. Instead, you’ll report one of three codes:

• 28001 (Incision and drainage, bursa, foot)
• 28002 (Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space)
• 28003 (… multiple areas)

Again, precise code choice is critical for reimbursement in these procedures. Foot bursa I&Ds are listed under the surgery codes, which will lead to a higher reimbursement rate for your practice.

Know When to Use 10060 Instead

In the below example, you will see when it would be appropriate to use 10060 instead.

Procedure: The podiatrist used a No. 11 scalpel to make a simple incision over the target area of a simple, cutaneous abscess located in the heel of the patient’s right foot. The area was red, swollen, and appeared to be filled with pus. The podiatrist opened the abscess, which was at the dermis level of the skin, and removed the inflamed fatty and dead tissue within the cavity and completely drained the pus. The podiatrist then irrigated the wound and put a dressing on it. The patient was diagnosed with a cutaneous abscess of the right foot.

Answer: You should report 10060 for this I&D procedure. You should also report L02.611 (Cutaneous abscess of right foot) as the diagnosis code.

Explanation: In this scenario, the podiatrist carried out a basic incision and drainage procedure for a single lesion. This involves draining an abscess located in the skin’s superficial layers, typically the dermis, epidermis, or subcutaneous layers, without any deeper or extensive involvement. When draining a simple abscess, the podiatrist typically makes a straightforward incision to release the pus contained within the abscess.

Don’t miss: The code descriptor for 10060 describes what qualifies as an abscess, which includes the following:

• Carbuncle
• Suppurative hidradenitis
• Cutaneous or subcutaneous abscess
• Cyst
• Furuncle
• Paronychia.