"When billing for abscess procedures, coders need to look beyond the integumentary (skin) section of the CPT manual and use musculoskeletal codes when appropriate because these procedures reimburse at a higher rate than integumentary abscess codes. Sometimes, careful examination of the operative report may indicate that the surgeon went below the fascia into the muscle tissue and perhaps as far as the bone.
Many coders overlook the musculoskeletal section because so much of their work is focused in the integumentary section of the manual (10000 series codes) or because the documentation provided by the surgeon does not clearly indicate the location of the abscess.
Treating abscesses of the foot presents a further documentation challenge because many superficial procedures involving the foot have become Health Care Financing Administration (HCFA) targets due to their incorrect use by some podiatrists. When performing incision and drainage (I&D) on superficial or deep abscesses, documentation that carefully notes the location of the abscess is required, much the same as with a similar abscess in another region of the body. The documentation also serves to convince wary carriers that the procedure actually took place and was medically necessary.
Finding the Right Code
Like wound repair and lesion excisions, abscess codes are found both in the integumentary and musculoskeletal section of the CPT manual, but new coders may not be aware of this, says Kathy Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. There is a common misconception among inexperienced coders that these procedures begin and end with the integumentary section, so many procedures are billed under the integumentary umbrella without anyone looking at other coding options available to surgeons, she says.
The integumentary system consists of two layers: cutaneous tissue (epidermis and dermis) and subcutaneous tissue. Below the subcutaneous tissue is a layer of fibrous tissue called the fascia that marks the beginning of the musculoskeletal system. This means that the code for an incision that goes through the fascia is not found in the integumentary section of the CPT manual.
The I&D of abscesses in cutaneous and subcutaneous tissue is coded 10060* (incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia]; simple or single). Complicated or multiple abscesses are coded 10061.
These two codes apply to abscesses found on any body region. In other words, a subcutaneous abscess of the arm is coded the same as an abscess of the surface of the foot.
This is not the case, however, if the incision penetrates [...]