Podiatry Coding & Billing Alert

Question: Our podiatrist visited an established patient at a nursing home but noted an infection and tineapedis not previously seen. His notes describe an I&D on the Left Hallux and he also wrote orders for the tineapedis. Additionally, he performed nail care 11721 with Q8. How should I code this encounter? Please share some info on the I&D procedure.

Missouri Subscriber

Answer: As the visit was a subsequent visitation to a nursing home for an established patient, you should report the visit with code 99307 (Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …) attached with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other zervice). This is based on the assumption that your physician spent an average of 10 minutes face to face with the patient and on the unit or floor and fulfilled at least two of three key components to support the service level. As he performed an Incision and drainage (I&D), you should report code 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single). You are correct in coding 11721 (Debridement of nail[s] by any method[s]; 6 or more) with the required modifier Q8 (Two [2] Class B findings). However, you also need to attach modifier 59 (Distinct procedural service) with this code as 11721 is included in code 10060 as per CCI edit.

In an I&D procedure, the podiatrist incises and drains a collection of pus, such as a carbuncle, hydradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. The physician may use a local anesthetic. The physician makes a circumferential incision over the target area of abscess through the skin and down to the level of abscess cavity, opens the abscess and excises all the inflamed fatty tissues within the cavity and drains the pus completely. You should report this code only if the physician performs incision and drainage of an abscess with simple procedure and single cyst only.