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Abscess

Nancy Posted Thu 20th of May, 2010 18:10:48 PM

Our doctor saw a patient at the hospital for a gigantic abscess of the left shoulder and posterior lateral chest 30 cm x 30 cm x10 cm. He did an Incision and Drainage of the gigantic complex left shoulder and chest wall abscess. He also did a wide excisional debridement of necrotic tissue left posterolateral chest wall with scalpel and scissor to the level of the thoracic chest wall fascia. We billed a 23030, 21501 & 11043. Insurance is denying as bundled. Was this billed correctly? Thank You for your help.

SuperCoder Answered Fri 21st of May, 2010 07:35:33 AM

As per the CCI edits, none of these 3 codes are bundled with each other. There is a possibility that insurance has taken the I&D of chest wall and excisional debridement of chest wall as bundled. Please check if the OP notes clearly mentions the I&D and excisional debridement (of chest wall) as two significantly separate and medically necessary procedure for better healing of the large abscess. You may re-submit the claim along with the OP notes to substantiate your claim. Also, do check with your payer, if use of modifiers like 59 or 51 is necessary with the CPT codes.

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