Podiatry Coding & Billing Alert

Question: A patient reported back to our physician for a wound check following drainage of a simple abscess in his abscess in the 1st metatarsal-phalangeal joint of the right foot. Our physician examined the wound and decided to drain it again. How do we report this repeat drainage? Would the same CPT^® codes be applicable for incision and drainage of a blister caused due to obesity?

New Jersey Subscriber

Answer: Since this is a repeat drainage, you need to find out the number of days elapsed since the first drainage the patient underwent. If the first procedure was incision and drainage (I&D) of a deep abscess, (deep abscess of the 1st metatarsal-phalangeal joint and the incision was made through the subcutaneous tissue through and to the level of the extensor hallucis longus tendon and 1st metatarsal-phalangeal joint capsule), then the global period for 28002 (Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space) is 10 days for drainage of a foot abscess. Repeat I&D within this period by your physician would require use of the modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) modifier. Similarly, for a simple I&D, if the patient reports to the clinic within 10 days after the first time the abscess was drained, then you only report 28001 (Incision and drainage, bursa, foot). The wound check here is bundled into the drainage.

However, if the patient returned to the clinic beyond 10 days, you report 28001 for the drainage and 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making...) for the wound check.

For the toe blisters (without infection), unfortunately, no code exists. There is no code for billing I&D on something other than abscess, cellulitis, carbuncle, furuncle, cheilitis, or hidrenitis (all of which involve infection). Your two options are to try 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue) and send records, or just include the work of the I&D in your E/M code.