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Bianca Posted Fri 24th of February, 2017 10:55:20 AM
My doctor did surgery on a diabetic patient with cutaneous and subcutaneous abscess of the groin area and perineum. 4 separate incisions were made to drain the abscess as well as manual dissection of the abscess itself and the surrounding tissue. I am thinking to code 11004 with a dx of L03.314 and L03.315. Please advise if you think this would be appropriate. Thank you
SuperCoder Answered Mon 27th of February, 2017 05:08:53 AM

CPT code 11004 is for the debridement of skin, whereas your procedure is for incision and drainage, so CPT 11004 is not the correct code to bill. CPT code 10061 is appropriate code for incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple abscess. In the procedure the patient is appropriately prepped and anesthetized and provider incises the area of abscess to be excised and drains the collection of pus, such as those related to a carbuncle, hidradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. A complicated incision and drainage involves multiple incisions, drain placements, extensive packing, and subsequent wound closure. Dx codes are correct. Add Dx code for diabetes as well.

Bianca Posted Mon 27th of February, 2017 15:23:43 PM
The doctor did dissection of surrounding tissue, would that not qualify for debridement?
SuperCoder Answered Tue 28th of February, 2017 08:16:48 AM

Debridement is the removal of damaged tissue, this process is also follow in I&D, which is done in your case. But as per description provided by you is appropriate for CPT 10061. In this CPT code, the physician makes the incision through the skin overlying an abscess for incision and drainage. The abscess or cyst is opened with a surgical instrument, allowing the contents to drain, mechanically or manually. The lesion may be curetted and irrigated. The physician leaves the surgical wound open to allow for continued drainage or the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage then surgical closure. Check your whole op-report, match with the code description and bill.

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