Supercoder - Ask an Expert? Forum: Ed Coding

Supercoder - Ask an Expert? Forum: Ed Coding - Recent Posts http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Ed Coding - Recent Posts en Sun, 12 Feb 2012 09:45:13 +0000 Maiu Reismann on "10060-100601 vs 26010-26011" http://www.supercoder.com/forum/topic/10060-100601-vs-26010-26011#post-11349 Fri, 10 Feb 2012 22:23:49 +0000 Maiu Reismann 11349@http://www.supercoder.com/forum/ Should drainage of finger abscess be billed using 10060-10061 or 26010-26011? Paula K Turner on "ER NG tube inssertion" http://www.supercoder.com/forum/topic/er-ng-tube-inssertion#post-11132 Thu, 02 Feb 2012 19:39:41 +0000 Paula K Turner 11132@http://www.supercoder.com/forum/ Sanjit, If the nurse inserts the NG tube then we are unable to code 43753 because it requires a physician skill, correct? Sanjit Mishra on "ER NG tube inssertion" http://www.supercoder.com/forum/topic/er-ng-tube-inssertion#post-11120 Thu, 02 Feb 2012 17:20:45 +0000 Sanjit Mishra 11120@http://www.supercoder.com/forum/ For simple placement of a NG/OG tube by a physician for aspiration/lavage (e.g. poisonings, GI bleeds) code 43753 (Gastric intubation, and aspiration(s) therapeutic, necessitation physician's skill (e.g., for gastrointestinal hemorrhage), including lavage if performed) is used. When fluoroscopy is used the appropriate code to report this service would be CPT code 43752, naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance. It will be necessary to document a procedure note describing the reason a physician's skill was required and evidence reporting that fluoroscopy was used. Both of the above codes for this procedure are bundled into critical care (99291) and should not be coded separately if performed during the critical care episode. Paula K Turner on "ER NG tube inssertion" http://www.supercoder.com/forum/topic/er-ng-tube-inssertion#post-11084 Wed, 01 Feb 2012 17:18:36 +0000 Paula K Turner 11084@http://www.supercoder.com/forum/ If the nurse inserts the NG tube in the ER, what CPT code would you recomment for technical side? Sanjit Mishra on "Medicare and 90715" http://www.supercoder.com/forum/topic/medicare-and-90715#post-11037 Tue, 31 Jan 2012 15:41:16 +0000 Sanjit Mishra 11037@http://www.supercoder.com/forum/ Diphtheria, tetanus toxoid, and whole-cell or acellular pertussis vaccines: CPT codes covered if selection criteria are met: 90471 + 90472 90700 90701 90715 ICD-9 codes covered if selection criteria are met: V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP] Other ICD-9 codes related to the : V03.5 Need for prophylactic vaccination and inoculation against bacterial diseases, diphtheria alone V03.6 Need for prophylactic vaccination and inoculation against bacterial diseases, pertussis alone V03.7 Need for prophylactic vaccination and inoculation against bacterial diseases, tetanus toxoid alone V06.5 Need for prophylactic vaccination and inoculation against combinations of diseases, tetanus-diphtheria [Td] [DT] Combination vaccination with diphtheria-tetanus-acellular pertussis, and inactivated polio (DTaP-IPV) (Kinrix™, GlaxoSmithKline): CPT codes covered if selection criteria are met: 90471 + 90472 90696 ICD-9 codes covered if selection criteria are met: V06.3 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis with poliomyelitis [DTP+polio] Combination vaccination with diphtheria-tetanus-acellular pertussis (DTaP), inactivated polio, and hepatitis B (Pediatrix®, GlaxoSmithKline): CPT codes covered if selection criteria are met: 90471 + 90472 90723 ICD-9 codes covered if selection criteria are met: V05.3 Need for prophylactic vaccination and inoculation against single diseases, viral hepatitis V06.3 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis with poliomyelitis [DTP+polio] Other ICD-9 codes related to the: V03.5 Need for prophylactic vaccination and inoculation against bacterial diseases, diphtheria alone V03.6 Need for prophylactic vaccination and inoculation against bacterial diseases, pertussis alone V03.7 Need for prophylactic vaccination and inoculation against bacterial diseases, tetanus toxoid alone V04.0 Need for prophylactic vaccination and inoculation against certain diseases, poliomyelitis V06.5 Need for prophylactic vaccination and inoculation against combinations of diseases, tetanus-diphtheria [Td] [DT] Combination vaccination with diphtheria-tetanus-whole-cell perussis (DTP) and haemophilis influenza type b (Hib) (TriHiBit™, Aventis Pasteur, Inc.): CPT codes covered if selection criteria are met: 90471 + 90472 90720 ICD-9 codes covered if selection criteria are met: V03.81 Need for prophylactic vaccination and inoculation against Hemophilus influenza, type B [Hib] V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP] Immunization with DTaP, DTP, tetanus toxoid (TT), or tetanus and diphtheria toxoids (Td): CPT codes covered if selection criteria are met: 90471 + 90472 90702 90703 90714 90718 ICD-9 codes covered if selection criteria are met: 800.50 - 800.99 Fracture of vault of skull, open 801.50 - 801.99 Fracture of base of skull, open 802.1 Fracture of nasal bones, open 802.30 - 802.39 Fracture of mandible, open 803.50 - 803.99 Other and unqualified skull fractures, open 804.50 - 804.99 Multiple fractures involving skull or face with other bones, open 805.1, 805.3, 805.5, 805.7, 805.9, 806.10 - 806.19, 806.30 - 806.39, 806.5, 806.70 - 806.79 Fracture of vertebral column, open 807.10 - 807.19, 807.3, 807.6 Fracture of rib(s), sternum, larynx, and trachea, open 808.1, 808.3, 808.51 - 808.59 Fracture of pelvis, open 809.1 Fracture of bones of trunk, open 810.10 - 810.13, 811.10 - 811.19, 812.10 - 812.19, 812.30, 812.31, 812.50 - 812.59, 813.10 - 813.18, 813.30 - 813.33, 813.50 - 813.54, 813.90 - 813.93, 814.10 - 814.19, 815.10 - 815.19, 816.10 - 816.13, 817.1, 818.1, 819.1 Fracture of upper limb, open 820.10 - 820.19, 820.30 - 820.32, 820.9, 821.10, 821.11, 821.30 - 821.39, 822.1, 823.10 - 823.12, 823.30 - 823.32, 823.90 - 823.92, 824.1, 824.3, 824.5, 824.7, 824.9, 825.1, 825.30 - 825.39, 826.1, 827.1, 828.1, 829.1 Fracture of lower limb 830.1 Dislocation of jaw, open 831.10 - 831.19, 832.10 - 832.19, 833.10 - 833.19, 834.10 - 834.12 Dislocation of upper limb, open 835.10 - 835.13, 836.4, 836.60 - 836.69, 837.1, 838.1 Dislocation of lower limb 839.10 - 839.18, 839.30, 839.31, 839.50 - 839.59 Dislocation of vertebra, open 839.71 Dislocation of sternum, open 851.10 - 851.19, 851.30 - 851.39, 851.50 - 851.59, 851.70 - 851.79, 851.90 - 851.99, 852.10 - 852.19, 852.30 - 852.39, 852.50 - 852.59, 853.10 - 853.19, 854.10 - 854.19 Intracranial injury, excluding those with skull fracture, open 860.1, 860.3, 860.5, 861.10 - 861.13, 861.30 - 861.32, 862.1, 862.31 - 862.39, 862.9, 863.1, 863.30 - 863.39, 863.50 - 863.59, 863.90 - 863.99, 864.10 - 864.19, 865.10 - 865.19, 866.10 - 866.13, 867.1, 867.3, 867.5, 867.7, 867.9, 868.10 - 868.19, 869.1 Internal injury of thorax, abdomen, and pelvis, open 870.0 - 897.7 Open wound 910.0 - 919.9 Superficial injury 940.0 - 949.5 Burns V03.7 Need for prophylactic vaccination and inoculation against bacterial disease, tetanus toxoid alone V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP] Combination vaccination with diphtheria-tetanus toxoids-acellular pertussis, inactivated poliovirus and Haemophilis influenza type b (DTaP-Hib-IPV) (Pentacel®, Sanofi Pasteur, Inc.): CPT codes covered if selection criteria are met: 90471 + 90472 90698 ICD-9 codes covered if selection criteria are met: V03.81 Need for prophylactic vaccination and inoculation against Hemophilus influenza, type B [Hib] V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP] Try Super on "Medicare and 90715" http://www.supercoder.com/forum/topic/medicare-and-90715#post-11010 Mon, 30 Jan 2012 19:06:17 +0000 Try Super 11010@http://www.supercoder.com/forum/ We are an Urgent Care facility with clinics across the US. We see many Medicare patients and treat open wounds, abbrasions, burns, etc. Medicare guidelines state the with a valid accident code the 90715 and other vaccines are covered. However, this code continually denies and has to be appealed. The 90718 is payable and we have no issues with it. The 90715 from my understanding should be paid without having to appeal every one. We are talking about hundreds of these procedures across the country every year. Is there any other codes or modifiers that can be added to get this code paid the first time? Sanjit Mishra on "Sling" http://www.supercoder.com/forum/topic/sling#post-10954 Fri, 27 Jan 2012 19:49:59 +0000 Sanjit Mishra 10954@http://www.supercoder.com/forum/ Per AHA Coding Clinic for HCPCS ace bandages and slings are often used with casts and splints and are not separately reportable. However, the supply may be billed separately. Without specific guidance, the best practice is to consider these supplies as part of the E/M service. Maiu Reismann on "Sling" http://www.supercoder.com/forum/topic/sling#post-10947 Fri, 27 Jan 2012 19:05:33 +0000 Maiu Reismann 10947@http://www.supercoder.com/forum/ Can sling be billed separately? Sanjit Mishra on "73562 and 51" http://www.supercoder.com/forum/topic/73562-and-51#post-10945 Fri, 27 Jan 2012 18:42:57 +0000 Sanjit Mishra 10945@http://www.supercoder.com/forum/ Preferred:- 73562-RT 73562-59,LT Maiu Reismann on "73562 and 51" http://www.supercoder.com/forum/topic/73562-and-51#post-10914 Fri, 27 Jan 2012 10:02:10 +0000 Maiu Reismann 10914@http://www.supercoder.com/forum/ If '73562' Radiologic examination, knee; 3 views is performed on LT and RT knee, what is the proper way to bill? Is 51 added to the second code? 73562 RT 73562 LT 51 or 73562 RT/LT billed with modifier 50? Mary Murkerson on "splint billing in er" http://www.supercoder.com/forum/topic/splint-billing-in-er#post-10874 Thu, 26 Jan 2012 14:29:22 +0000 Mary Murkerson 10874@http://www.supercoder.com/forum/ We had a splint applied in the ER by the nurse not the provider- can we bill for this procedure on the facility side and not the pro fee? Maiu Reismann on "99204" http://www.supercoder.com/forum/topic/99204-1#post-10870 Thu, 26 Jan 2012 09:09:15 +0000 Maiu Reismann 10870@http://www.supercoder.com/forum/ Can E/M code 99204 be assigned if History is Comprehensive, PE is Detailed and Medical decision making is Low and patient has pneumonia? Jennifer Blake on "Ligation of a ruptured vericose vein" http://www.supercoder.com/forum/topic/ligation-of-a-ruptured-vericose-vein#post-10844 Wed, 25 Jan 2012 20:09:41 +0000 Jennifer Blake 10844@http://www.supercoder.com/forum/ What if no incision is made for a bleeding vericose vein, and only one suture is used to stop the bleeding, would you still use 37785? Upon reading the description in Encoder, it seems there is more work involved in the 37785 procedure. Thank you Sanjit Mishra on "26010" http://www.supercoder.com/forum/topic/26010-1#post-10677 Thu, 19 Jan 2012 20:24:18 +0000 Sanjit Mishra 10677@http://www.supercoder.com/forum/ Splint(29130-59)/strapping(29280) should be billed separately. Maiu Reismann on "26010" http://www.supercoder.com/forum/topic/26010-1#post-10653 Thu, 19 Jan 2012 15:31:28 +0000 Maiu Reismann 10653@http://www.supercoder.com/forum/ Does '26010' Drainage of finger abscess include splint/strapping or can it be billed separately? Leesa Israel on "Patient Balance Time Limit?" http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10633 Wed, 18 Jan 2012 23:07:03 +0000 Leesa Israel 10633@http://www.supercoder.com/forum/ Wow. That is odd, Tanya. * I agree that it makes no sense that the patient has received statements and just because he has refused to pay you in those two years you are forced to write it off. If that loophole existed I would think everyone would just sit on their bills for years! :-) * That said, I would suggest you might want to consult your practice's attorney if the patient continues to bring up legal defense. I assume you have records of when statements were sent out and such. Do you use a collections agency? Perhaps they could offer advice specific to your state's laws as well? * My one caveat again is that I don't know where you are located and don't know your state specific laws, so there may be some loophole somewhere in your state laws. Again, that's why I'd suggest asking a local attorney. * Best of luck! * ~Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Home office: (866) 458-2973 Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> TANYA PEREZ on "Patient Balance Time Limit?" http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10630 Wed, 18 Jan 2012 22:26:21 +0000 TANYA PEREZ 10630@http://www.supercoder.com/forum/ Thank you for your response. In this case, it was not the patient's initial receipt of the bill. He has been receiving it for quite some time, and is now fighting back stating he is a lawyer, and since the charges are so old we are legally obligated to adjust this. I did not think this to be right... That would say that a patient can just sit on a bill until the two years are up, which would not make any sense. Why would any patient pay there balance if that be the case? Thank you for confirming my conclusion. You guys rock. Sanjit Mishra on "Foreign body removal" http://www.supercoder.com/forum/topic/foreign-body-removal-2#post-10554 Tue, 17 Jan 2012 11:25:58 +0000 Sanjit Mishra 10554@http://www.supercoder.com/forum/ Check the documentation, I think it will better suit for 10121 Leesa Israel on "12001" http://www.supercoder.com/forum/topic/12001-1#post-10549 Tue, 17 Jan 2012 02:19:57 +0000 Leesa Israel 10549@http://www.supercoder.com/forum/ Medicare changed the payment policy for simple laceration repairs in 2011 by changing the global surgical package from ten days to zero days. Basically this means that the follow-up visit for a wound check and suture removal is no longer included in the payment for suturing, stapling or using tissue adhesives on superficial wounds primarily involving the epidermis or dermis without deeper damage. * Rationale: The change came about in part because Medicare officials did not believe it was typical for emergency department patients to return to the ED where the sutures were placed to have them removed ten days later. Veteran coders will recall when simple laceration repairs were designated as starred procedures (*) in CPT®, meaning that the global surgical package concept did not apply to the indicated code. When that CPT® construct was removed in 2004, the simple repair codes took on a ten day global period, meaning all typical post operative follow up care was included in the payment and should not be reported separately if provided by the same physician. * There was confusion last year over how to report the follow-up visit when patients do return to the ED for suture removal and it is outside of the defined global surgical period. Medicare advised using an ED E/M code. This reporting strategy is consistent with the clinical example in Appendix C of the CPT® manual describing a visit for a patient to have “sutures removed from a well healed uncomplicated laceration.” * Keep in mind that private payers often follow Medicare global periods and payment policies, so you could use the same approach; but verify that each payer’s global period and resulting payment has actually changed before you start reporting the follow up visit for those patients. This fairly new practice may cause confusion for ED patients who are used to having their sutures removed for free; patients may be even more upset if they are faced with an additional ED visit co-pay, often over $100, for the follow-up visit. * I hope this helps. * Best, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Home office: (866) 458-2973 Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> Maiu Reismann on "12001" http://www.supercoder.com/forum/topic/12001-1#post-10538 Mon, 16 Jan 2012 20:07:36 +0000 Maiu Reismann 10538@http://www.supercoder.com/forum/ CPT code '12001' has a 0 day global period as per Medicare. In this case, would suture removal be billed as a separate visit or is it included? I would think that 0 day global would allow to bill separately for the follow up visit. Yet I have heard that suture removal is always included in the surgical procedure. Maiu Reismann on "Foreign body removal" http://www.supercoder.com/forum/topic/foreign-body-removal-2#post-10526 Mon, 16 Jan 2012 15:24:55 +0000 Maiu Reismann 10526@http://www.supercoder.com/forum/ Does infected embedded earring removal qualify for 10120? Leesa Israel on "Patient Balance Time Limit?" http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10388 Thu, 12 Jan 2012 13:25:27 +0000 Leesa Israel 10388@http://www.supercoder.com/forum/ Hi Tanya. * I wanted to check with a colleague to be sure my initial thoughts were correct and she confirmed my thinking. The only issue you might run into is if your state has any laws preventing this. You should check on state regs but otherwise, we think you'd be okay to bill the patient at any point. * That said, we both agree that if the patient has never been billed for the service before (as in, you're billing them for the first time 2-3 years after the service) that's not the best PR move and you're not likely going to get paid. My colleague agrees. Here's what she said: * "BUT if you get a patient really ticked off by billing them for the first time a long time after the service, leaving them to think that they don’t owe you because they had not received a statement since the service, and it had been a long time, to quote the person who asked the question, “Say after two-three years”, you will probably run into a very unhappy EX-patient who tells everyone how bad your office is and who may complain to the state medical board and who may get you investigated for your business practices. I have seen this happen with a doctor who set his fees where he wanted to set them and balance billed patients in a non par situation which he had every right to do, but the amount he expected them to pay was so much more than the insurance allowed amounts for R&C that complaints were made to the state medical board and he was audited and it was found that he made coding errors and then he had legal problems. The doctor is entitled to their money, but it is not fair to the patient to be a lousy business person and they are tempting fate when they bill in this way, IMHO and experience. * And an unhappy patient tells 10 people who tells 10 people who tells 10 people, etc. That is not a great marketing plan." * Thanks, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Home office: (866) 458-2973 Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> Birendra Meher on "10021 vs 10160" http://www.supercoder.com/forum/topic/10021-vs-10160#post-10386 Thu, 12 Jan 2012 12:16:15 +0000 Birendra Meher 10386@http://www.supercoder.com/forum/ I think there is no big difference between these two codes. For me, the main difference is needle size and it is totally depend upon the nature of the cyst with size of the needle insertion. For 10021, surgeon uses FN means fine gauge needle (usually 18 to 25 gauge sizes) and a syringe to sample fluid or remove clusters of cells from a solid mass. Sometimes surgeon may make several passes to obtain an adequate tissue specimen and it is usually an aspirate, which is a mixture of fluid and cells. Whereas in 10160, surgeon uses a knife or a large bore needle to pierce a fluid filled cavity (such as bulla, cyst, hematoma, abscess etc.) and then withdraw the fluid using a syringe or suction device. Maiu Reismann on "10021 vs 10160" http://www.supercoder.com/forum/topic/10021-vs-10160#post-10378 Thu, 12 Jan 2012 05:41:12 +0000 Maiu Reismann 10378@http://www.supercoder.com/forum/ What is the difference between codes 10021 and 10160? Leesa Israel on "Patient Balance Time Limit?" http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10360 Wed, 11 Jan 2012 19:36:37 +0000 Leesa Israel 10360@http://www.supercoder.com/forum/ Hi Tanya. * I am looking into this for you and will get back to you just as soon as I can. I want to do a bit of research before giving an answer. * Thanks, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Home office: (866) 458-2973 Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> Birendra Meher on "multiple visits on the same day." http://www.supercoder.com/forum/topic/multiple-visits-on-the-same-day#post-10334 Wed, 11 Jan 2012 13:38:38 +0000 Birendra Meher 10334@http://www.supercoder.com/forum/ Yes, this is the correct way to bill and appropriate to append modifier-27 on ER visit code. This modifier is specifically used for separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date with different physicians. Note: This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date. For physician reporting of all outpatient E/M services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital ED, clinic), you should refer E/M, Emergency Department, or Preventive Medicine Services codes. Brenda Dumont on "multiple visits on the same day." http://www.supercoder.com/forum/topic/multiple-visits-on-the-same-day#post-10317 Tue, 10 Jan 2012 23:25:54 +0000 Brenda Dumont 10317@http://www.supercoder.com/forum/ We bill for a hospital/clinic in bush Alaska. They have outpatient clinics in addition to a full service hospital. We had a patient come in to the clinic for e/m service at 14:05, then returned to the ER at 19:15 the same day. The insurance is denying the second visit as included in the 1st visit. The diagnosis was the same, but different places of service and different physicians. We applied modifier 27 to the ER visit. Is this the correct way to bill this? TANYA PEREZ on "Patient Balance Time Limit?" http://www.supercoder.com/forum/topic/patient-balance-time-limit#post-10313 Tue, 10 Jan 2012 22:28:18 +0000 TANYA PEREZ 10313@http://www.supercoder.com/forum/ Is there a time frame to be allowed to bill a patient for their balance due after the insurance company processes the claim? Say after two-three years, if the patient still owes a balance(according to insurance's allowed charges) are we be able to still bill the patient? Sanjit Mishra on "10060" http://www.supercoder.com/forum/topic/10060-1#post-10090 Wed, 04 Jan 2012 16:51:33 +0000 Sanjit Mishra 10090@http://www.supercoder.com/forum/ 10060-10061, defines the procedure as “incision and drainage of abscess (carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single and complex or multiple. * GUIDELINES: 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 Maiu Reismann on "10060" http://www.supercoder.com/forum/topic/10060-1#post-10086 Wed, 04 Jan 2012 16:10:56 +0000 Maiu Reismann 10086@http://www.supercoder.com/forum/ Can 10060 be used if no pus was drained?