Loretta Posted Tue 30th of May, 2017 17:50:25 PM
What is the CPT code for the following procedure:
POSTOPERATIVE DIAGNOSIS: Infected left groin area.
1. Incision and drainage of left inguinal hernia abscess.
2. Excisional debridement of left inguinal hernia.
WOUND CLASS: Dirty or infected.
PROCEDURE IN DETAIL: The patient was prepped and draped in supine position.
Surgical safety check-out was performed. The left inguinal area was prepped
and draped in usual sterile fashion in supine position and a #15 blade was
used to make 10 cm incision over the left inguinal area of induration,
multiple areas of purulence encountered. This was cultured and completely
irrigated. Sharp and Bovie dissection was used to dissect through the skin
and soft tissue. All areas of induration or purulence were completely
explored and drained. 1 L of normal saline irrigation was used and the wound
was packed with Betadine-soaked Kerlix
SuperCoder Answered Wed 31st of May, 2017 05:54:28 AM
As per procedure description, CPT 10061 is appropriate code. In this procedure, the physician makes a small incision through the skin overlying an abscess for incision and drainage (e.g., carbuncle, cyst, furuncle, paronychia, hidradenitis). The abscess or cyst is opened with a surgical instrument, allowing the contents to drain. The lesion may be curetted and irrigated. CPT 10061 is for complex or multiple abscess.
Use ICD L03.314 if the infection is cellulitis or use L02.214 for cutaneous abscess.