Wiki Biopsy and I&D of same lesion

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peachygirl

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Hello,
Just looking for clarification, doctor billed for 11100, 10060, and 12021--these were all performed on the same lesion (dx "Underlying nevus that is secondarily infected resulting in cellulitis and abscess formation"), here's how the note reads:
"Biopsy done, culture done, I&D done, abcess is 2 cm deep: packed with nugauze, pressure dressing, Bactrim DS bid"

Basically, I am wondering if we can bill for all three procedures when they are performed on the same lesion?

Thank you!
Mallory, CPC
 
Hi Mallory:

Documentation does not support 12021, treatment of superficial wound dehiscence with packing. I would code the nevus bx and code the abscess I&D as complicated, 10061, since packing was placed.

Packing, the break up of loculations or drain placement are some documentation clues of a complicated skin I&D.
 
Report only 10061.
There is a CCI edit for all three. Biopsy same site is included in procedure, also there were no closure.

MS
 
Hi MS:

Simple closure can be done but is not necessary with the 11100. I did not see an NCCI edit with 10061 and 11100, only 12021 (which was not documented) and 11100.
 
These categories are to be individualized.
Only during surgical procedures- those mostly/mandatorily involve the biopsy submission for pathlogical examination (like excision, destruction or shave removal), are bundled into the major surgical procedures. But I&D of an abscess/cellulitis, does not necessarily involve biopsy. [Here it is understandable the submission(collection) of pus for culture is a part of the abscess procedure] But biopsy in abscess/cellultis is a separate and not a component of of I & D at all. So this biopsy should be reported separately. Basically, I & D procedures of an abscess in integumentary system are not closed with suture. The sutures are not taken up. It is left with drainage, or package or simply with dressing alone. So there is no need for suture or closure and the packing is a component of the I & D.

The “superficial wound dehiscence” means- a surgical wound of the past, which had been closed then at the time of surgery, has given way at sometimes later and necessitates a closure again now at this time. So this (repair code) does not apply for this scenario, meaning 12020 does not apply.
To be precise, no need for a code for packing. Biopsy and I& D alone have to be reported separately.
 
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