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CPT 10060 with no incision
He states, "They were not draining, but I was able to express pus by applying pressure from the abscesses without an incision"
Any idea where I can find something in writing for backup? Thanks!
Claim denial 10060 for I&D sebaceous cyst
I recently got a denial for a claim where a sebaceous cyst was drained from a patient’s face (LT cheek). ICD-10 code was billed as L72.3 with CPT code 10060. I checked the LCD and L72.3 is not covered. The CPT index directly refers you to 10060 for I&D sebaceous cyst. The LCD doesn’t even have unspecified cyst on the list and my provider does not feel abscess or cellulitis is appropriate. Has anyone else come across this?
Thanks,
Crystal
10060 vs 10061 using coding clinic second quarter 2017
Ask the Editor–and I apologize if this is a rehash.
A patient underwent an incision and drainage procedure at our facility. According to the operative report, an incision was made over the lesion and purulent material was expressed. Loculations were broken up using forceps and more of the material was expressed. The drainage cavity was then irrigated, packed and dressed with sterile gauze.
Would it be appropriate to code an incision and drainage (I&D) as complicated based on documentation that a drain or packing was used? There are many articles available that provide varying opinions and we would appreciate an official response. Should the term complicated be documented or may the coder use the drain or packing as an indicator of a complicated procedure?
ANSWER
No, it would be inappropriate for the coder to assume that the incision and drainage is complicated based on the use of a drain or packing without confirmation from the physician. When the documentation is unclear the coder should query the physician for clarification.
With that said my question is- If I’m not basing a complex I&D on whether the provider used packing or a drain, can use the fact that they probed for loculations, or explored the abscess further to come to a 10061(complex; multiple) for a more complex procedure? I’m asking in the absence of a query would probing and/or breaking up loculations be evidence of a complex I&D? According to the coding clinic we just can’t assume placement of a wick or drain is evidence of the complexity but it says nothing about probing, or breaking anything up shouldn’t be used to determine the complexity. I know it’s at the discretion of the provider, but unless they state it was complex OR if there was more than one abscess then what other indication is there to code a 10061 for the (complicated;multiple except for the obvious more than one)?
Do we call everything a simple I&D unless the provider states it’s complex?
Thank you!
11100 and 10060
Patient was a new patient and during the encounter had a skin lesion biopsied and a separate I&D of a cyst. CPTs billed were 99203 (25), 11100, 10060 – UMR paid 10060 and denied 11100 stating that it cannot be reported on the same day that a procedure was performed. Any ideas? To my knowledge it doesnt require modifier 59 but I could be wrong and overlooking something.