Billing and coding for I&Ds is something performed in nearly every Dermatology office in the country.  We have included a brief overview of the codes used and some common edits that will help get your incision and drainage claims paid the first time through.

 

CPT codes 10060/10061, 10080/10081, 10120/10121, 10140, 10160 and 10180

Code Descriptions
10060 I & D of abscess (cutaneous or subcutaneous abscess, cyst, or paronychia); simple or single
10061 I & D of abscess (cutaneous or subcutaneous abscess, cyst, or paronychia); complicated or multiple
10080 Incision and drainage of pilonidal cyst; simple
10081 Incision and drainage of pilonidal cyst; complicated
10120 Incision and removal or foreign body, subcutaneous tissues; simple
10121 Incision and removal or foreign body, subcutaneous tissues; complicated
10140 Incision and drainage of hematoma, seroma or fluid collection
10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
10180 Incision and drainage, complex, post-op wound infection

The above referenced CPT codes used for incision & drainage have a 10 day global period and are not approved for an assistant surgeon.  To be paid, adequate medical necessity must be justified.

Incision & Drainage CPT Codes Documentation
The following documentation must be present in the medical record:

1)    A detailed description of the abscess (location, signs/symptoms, appearance, size, etc)
2)    A culture and sensitivity test must be performed of the puss (puss is assumed in an I&D procedure)
3)    The treating physician must require and document that the patient is applying astringent soaps to the I&D site
4)    Patient must be prescribed a topical antibiotic or an oral antibiotic

For complicated cases (CPT 10061, 10081, 10121)
1)    Op report including the use of local anesthesia
2)    Patient must be prescribed an ORAL antibiotic

Diagnosis Codes associated with CPT Procedure Codes
*Please check with your local carrier for an exhaustive list

10060    I & D of abscess (cutaneous or subcutaneous abscess, cyst, or paronychia); simple or single
10061    I & D of abscess (cutaneous or subcutaneous abscess, cyst, or paronychia); complicated or multiple

CCI Edits

The following tables show codes that will not be paid if billed as component codes to the primary code.  The component codes may be paid if the procedure is performed on a separate anatomical site or as a distinct separate procedure.  The appropriate modifier must be appended to the primary code.  Modifiers that allow for payment are:
-TA, -T1, T2, -T3, -T4, -T5, -T6, -T7, -T8, -T9, -LT, -RT, -58, -59, -78, -79
*Component code 69990 is never payable even with an appropriate modifier

These following codes will not be paid if billed with CPT code 10060:

11055    11056    11057    11422    11423    11424    11426    11600
11601    11602    11603    11604    11606    11620    11621    11622
11623    11624    11626    11719    11720    11721    11730    11740
11765    20000    20005    20500    29580    64450    69990*    97597
97598    97602    97605    97606    G0127

These following codes will not be paid if billed with CPT code 10061:
10060    11055    11056    11057    11406    11424    11426    11604
11606    11623    11624    11626    11719    11720    11721    11730
11740    11750    11765    20005    20500    29580    64450    69990*
90780    97597    97598    97602    97605    97606    G0127

These following codes will not be paid if billed with CPT code 10080:

20500    64450    69990*

These following codes will not be paid if billed with CPT code 10081:
10080    20500    64450    69990*

These following codes will not be paid if billed with CPT code 10120:

11055/11056    11057    11719    11720    11721    64450    69990*    G0127

These following codes will not be paid if billed with CPT code 10121:
10120    11720    11721    64450    69990*

These following codes will not be paid if billed with CPT code 10140:

11055    11056    11057    11719    11720    11721    29580    64450
69990*    G0127

These following codes will not be paid if billed with CPT code 10160:

10061    10140    11055    11056    11057    11719    11720    11721
29580    64450    69990*    G0127


CPT codes, descriptions and other data only are copyright 2008 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

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