Looking for some clarification. Our GYN providers are using 10061 and 56405 codes interchangeably. I would code 56405 when the documentation states "I & D of Abscess/Furuncle of the vulva or perineal area". Others are coding 10061 for the same documentation. Any enlightenment would greatly be appreciated. (There is an exclude note under code 56405 that includes code 10061)
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Tag Archives: 10061
I&D documentation guidelines for coding 10060 vs 10061
I am looking for an "official" resource that actually provides guidance on what documentation constitutes a simple I&D (10060) versus a complex I&D (10061). I’m finding a variety of opinions and that a drain/packing takes the coding to complex 10061 but then I’m finding that if the physician states it was a complex then that is all that is needed to code the 10061. In order to fully educate the physicians we have, I need a official resource on what the documentation should state and the details it should provide. All of the physicians are listing details of size/site/anesthesia/procedure details/ etc but the only difference is some do not state the complexity and others do. Any one have any insight on this or a official website I can review. Thanks in advance!
Cpt 56405 vs 10061
I am trying to code an I&D – Abscess Perineum. Code 56405 matches this but directly above the code in the CPT book if says for incision and drainage of sebaceous cyst, furuncle, or abscess see 10040, 10060, 10061. Can anyone tell me which code i should be using? Why is there a code for this it it tells you to use something else. I am unclear on the difference. Thanks
10060 vs 10061 using coding clinic second quarter 2017
:confused:from the AHA coding clinic second Quarter 2017
Ask the Editor–and I apologize if this is a rehash.
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!