Primary Care Coding Alert

Know your procedures to make smart coding choices.

For a small group of 10 related codes, the integumentary incision and drainage (I&D) codes can create quite a surprising number of issues. So, we thought it would be useful to shed some light on these I&D procedures, especially on how they differ from the similar excision codes.

Here are four big insights that will help you code I&Ds with precision the next time they come across your desk.

Insight 1: Use Provider Discretion to Determine Simple or Complicated

Many of the I&D codes, such as 10060 (Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single) and 10061 (… complicated or multiple), are paired codes that stipulate the I&D procedure is either simple or complex. But don’t bother searching your CPT^® manual to find definitions for the terms, because you won’t find them there.

Instead, you will need to make sure your provider 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.

Insight 2: Understand the Difference Between I&D and Puncture Aspiration

Your provider removes fluid from a patient’s hematoma. Do you use 10140 (Incision and drainage of hematoma, seroma or fluid collection) or 10160 (Puncture aspiration of abscess, hematoma, bulla, or cyst)?

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.

Insight 3: Make Sure You Know What Condition Is Being Treated

As obvious as it may seem, many times the key to choosing the right I&D code is as basic as thoroughly reading the provider’s notes and comparing them to the I&D codes. So, as we have already seen, I&D of a hematoma is 10140, while I&D of a pilonidal cyst is either 10080 (Incision and drainage of pilonidal cyst; simple) or 10081 (… complicated). And for superficial foreign body removals (FBRs) you’ll use either 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (… complicated).

Coding alert: Remember that “10120/10121 should always be used for superficial FBRs in the skin (hence the code numbers’ location in the integumentary section), while site-specific codes like 24200 [Removal of foreign body, upper arm or elbow area; subcutaneous] are for deeper FBRs below the skin level, which is why the codes are in the musculoskeletal section of CPT^®,” Moore reminds coders.

Insight 4: Remember That I&Ds Require Incisions

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 and 10121 say, ‘Incision and removal of foreign body, subcutaneous tissues …’ [emphasis added] and there was no incision 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.