Primary Care Coding Alert

Question: A patient with a simple pilonidal cyst reports to the ED. The physician decides to incise and drain infected abscess material from the cyst before performing a more formal excision. The physician provided both services during the same visit. Can we code the I&D separately?

Georgia Subscriber

Answer: You can't report the I&D separately in this instance.

Explanation: CMS guidelines set forth in the Correct Coding Initiative (CCI) state, "In cases where, in the course of an excision of a lesion, an area of involvement is identified which requires drainage, either as a part of the procedure or to gain access to the area of interest, coding/billing for incision and drainage of this fluid collection would be inappropriate if the excision or other procedure is performed in the same session."

Result: You should leave 10080 (Incision and drainage of pilonidal cyst; simple) off of the claim.

Report 11770 (Excision of pilonidal cyst or sinus; simple) for the procedure. Don't forget to append ICD-9 code 685.0 (Pilonidal cyst; with abscess) to 11770 to prove medical necessity for the service.

-- Answers to You Be the Coder and Reader Questions reviewed by Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.