Podiatry Coding & Billing Alert

Your podiatrist’s bottom line may be depending on it.

Incision and drainage (I&D) procedures are integral to a podiatrist’s work. But just because you report them a lot doesn’t mean you’re getting them right. There’s a lot of I&D coding myths out there that need to be debunked, so you can keep you claims clean and your podiatrist’s accounts in the black.

Here are four of the most common I&D myths that persistently plague podiatrist practices. Read on to hear how our experts bust them for you.

Consult Provider Documentation for Complexity Definition

Myth 1: A coder can decide whether an I&D procedure is simple or complicated.

This myth is completely false. But while CPT^® does not provide definitions for simple or complex I&D procedures, that does not mean you can. Instead, you will need to make sure your podiatrist has documented one of the terms, as simple or complicated I&D code determination is solely up to them.

Why? “Per a Q&A that appeared in the December 2006 issue of CPT^® Assistant [Volume 16: Issue 12, p. 15], CPT^® does not define ‘simple’ or ‘complex’ in this context,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. Instead, “the CPT^® Assistant answer says, ‘the choice of code is at the physician’s discretion, based on the level of difficulty involved in the incision and drainage procedure,’” Moore adds.

So, provider documentation should determine whether you will code 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single) or 10061 (… complicated or multiple) for an I&D procedure.

Other things you should look for in the procedure documentation include tissue depth and the number of incisions the provider made, surgical closure, local anesthetic, wound packing, and possibly even the length of time the provider spent performing the procedure. “Complex incision and drainage would be deeper than the subcutaneous tissue,” said Daniel Waldman, DPM, FACFAS, of Blue Ridge Podiatry Associates, PA, in Asheville, North Carolina. “A more complex incision and drainage may eventually require surgical closure at a later date, local anesthetic, or packing the wound. Also, it might require multiple incisions.”

Ultimately, however, you will need to seek clarity from your podiatrist before assigning either 10060 or 10061 to the claim. And you should make sure you do, as a mistake in documenting these procedures could impact your bottom line: CMS’ nonfacility valuation for 10060 in 2023 is $124.31, while CMS is valuing 10061 at $210.60.

Remember I&Ds Require Incisions

Myth 2: You can use an I&D code for FBR.

Suppose your provider removes a wooden splinter from a patient just by using a needle and a pair of tweezers. Can you report an I&D code then? “The answer is ‘No,’ because the descriptors for 10120 [Incision and removal of foreign body, subcutaneous tissues; simple] and 10121 {… complicated] say, ‘Incision and removal of foreign body’ [FBR]. But there is no incision if the provider is just using needle and forceps,” says Moore.

In such cases, you may actually have to reach for an evaluation and management (E/M) code from 99201-99215 (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 FB removal (FBR), you can also use 10120 or 10121. 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^®,” Moore reminds coders.

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

• 28190 (Removal of foreign body, foot, subcutaneous)
• 28192 (… metatarsal)
• 28193 (… phalanx of toe)

Know the Difference Between I&D and Puncture Aspiration

Myth 3: To remove fluid from a patient’s hematoma, you use an I&D code.

This myth is partially correct. For 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.

The difference between the two codes lies in the procedure your provider uses. “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.

Puncture aspiration, on the other hand, “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,” Moore continues.

Know How to Code Bursa I&D

Myth 4: To remove fluid from a patient’s bursa, you can use 10060/10061 or 10140.

This myth is also incorrect, and a quick clinical refresher will tell you why. Bursae are fluid-filled sacs that are located over soft tissue to facilitate lubrication between bones and skin. Repetitive motion, injury, bone deformities, and conditions such as arthritis can cause the bursae to be inflamed, resulting in a condition known as bursitis. Usually, conservative treatments such as rest, better fitting shoes, or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) alleviate the condition, but in some extreme cases, surgery is necessary to drain the fluid from the sacs.

This 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, so the 2023 nonfacility fee for 28001 is $168.94, over $40 higher than a simple I&D documented with 10060.