Podiatry Coding & Billing Alert

Question: A patient had surgery for cellulitis/abscess on the left foot. I reported the I&D with 28002 (Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space). The podiatrist also performed excision biopsy of the left foot. The physician's note says, "The flexor tendon was identified underlying the first MPJ. It was noted to be with a tenosynovitis lesion with very boulbous mass, and entirely separated from the distal slip. The bulbous tendon was removed of any necrotic tissue." What code should I use?

North Carolina Subscriber

Answer: Simply, the I&D (28002) is probably all that you can bill. When performing incision and drainage (I&D) on superficial or deep abscesses, documentation that carefully notes the location of the abscess is required. This tells the carriers that the procedure is medically necessary.

Profit: Musculoskeletal abscess I&D codes reimburse at a significantly higher rate than their integumentary counterparts (10060, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single, and 10061, ... complicated or multiple). For example, 28002 has 3.74 Facility PE RVUs, while 10060 has only 1.1 Facility PE RVUs.