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L29194 INCISION AND DRAINAGE OF ABSCESS OF SKIN, SUBCUTANEOUS

AND ACCESSORY STRUCTURES

 

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

 

• Procedure codes 10060 and 10061 represent incision and drainage of an abscess involving the skin, subcutaneous and/or accessory structures.

o This includes the following types of abscess: furuncle, carbuncle, suppurative hidradenitis, an abscessed cyst, an abscessed paronychia, and/or other abscess involving the cutaneous and/or subcutaneous structures.

• Medicare will consider the use of incision and drainage of an abscess of the skin, subcutaneous and/or accessory structures to be medically reasonable and necessary for the treatment of a symptomatic abscess (e.g. inflamed, painful, tender) involving these structures. This includes the incision and drainage of the following types of abscess:

o Furuncle

o Carbuncle

o suppurative hidradenitis

o an abscessed cyst

o an abscessed paronychia; and/or

o Other abscess of cutaneous and/or subcutaneous structures.

• It would not generally be expected to see incision and drainage of an abscess of the skin, subcutaneous and/or accessory structures to be repeated frequently and/or multiple times.

o If frequent repeated incision and drainage is required, the medical record must reflect the reason for persistent/recurrent abscess formation, as well as any measures taken to prevent reoccurrence.

 

 

CPT/HCPCS Codes

 

10060 INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

10061 INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE

 

 

ICD-9 Codes that Support Medical Necessity

 

528.5 DISEASES OF LIPS

607.2 OTHER INFLAMMATORY DISORDERS OF PENIS

611.0 INFLAMMATORY DISEASE OF BREAST

680.0 CARBUNCLE AND FURUNCLE OF FACE

680.1 CARBUNCLE AND FURUNCLE OF NECK

680.2 CARBUNCLE AND FURUNCLE OF TRUNK

680.3 CARBUNCLE AND FURUNCLE OF UPPER ARM AND FOREARM

680.4 CARBUNCLE AND FURUNCLE OF HAND

680.5 CARBUNCLE AND FURUNCLE OF BUTTOCK

680.6 CARBUNCLE AND FURUNCLE OF LEG EXCEPT FOOT

680.7 CARBUNCLE AND FURUNCLE OF FOOT

680.8 CARBUNCLE AND FURUNCLE OF OTHER SPECIFIED SITES

680.9 CARBUNCLE AND FURUNCLE OF UNSPECIFIED SITE

681.02 ONYCHIA AND PARONYCHIA OF FINGER

681.10 UNSPECIFIED CELLULITIS AND ABSCESS OF TOE

681.11 ONYCHIA AND PARONYCHIA OF TOE

682.0 CELLULITIS AND ABSCESS OF FACE

682.1 CELLULITIS AND ABSCESS OF NECK

682.2 CELLULITIS AND ABSCESS OF TRUNK

682.3 CELLULITIS AND ABSCESS OF UPPER ARM AND FOREARM

682.4 CELLULITIS AND ABSCESS OF HAND EXCEPT FINGERS AND THUMB

682.5 CELLULITIS AND ABSCESS OF BUTTOCK

682.6 CELLULITIS AND ABSCESS OF LEG EXCEPT FOOT

682.7 CELLULITIS AND ABSCESS OF FOOT EXCEPT TOES

682.8 CELLULITIS AND ABSCESS OF OTHER SPECIFIED SITES

682.9 CELLULITIS AND ABSCESS OF UNSPECIFIED SITES

705.83 HIDRADENITIS

 

 

Documentation Requirements

• Medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed.

o As stated in the "Coding Guidelines" section, the medical record must clearly indicate that an abscess was present.

o This should include the location, size, and appearance of the abscess.

• In addition, documentation that the service was performed (incision and drainage of purulent material from an abscess) must be included in the patient’s medical record.

o This information is normally found in the office/progress notes, hospital notes, and/or procedure report.

• Furthermore, the medical record must clearly document the medical necessity for repeated incision and drainage of an abscess.

o If frequent incision and drainage is required, the medical record must reflect the reason for persistent/recurrent abscess formation, as well as any measures taken to prevent reoccurrence.

o For example, for repeated incision and drainage of an abscessed paronychia, the medical record should document any additional measures taken to prevent reoccurrence and/or the reason for not performing more definitive treatment (e.g., the patient refuses and/or is not a candidate for permanent, partial or complete nail and nail matrix removal).

 

 

Treatment Logic

• An abscess is a cavity containing pus surrounded by inflamed tissue.

• It is generally associated with pain, swelling and erythema.

• An abscess often requires incision and drainage to remove the purulent material in order for healing to occur.

 

 

Sources of Information and Basis for Decision

 

Marx, J; Hockberger, R; Wakks, R. (2002). Rosen’s Emergency Medicine, Concepts and Clinical Practice, 5th edition. Pages 1949-1953, Mosby’s, Inc.

 

Richards, T. Skin or Soft Tissue Abscess. McKesson Health Solutions LLC. (2004).

 

Roberts, J; Hedges, J (2004). Clinical Procedures in Emergency Medicine, 4th ed. Pages 718-746, Elsevier, Inc.

 

02/02/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD INCISION AND DRAINAGE OF ABSCESS OF SKIN, SUBCUTANEOUS AND ACCESSORY STRUCTURES

 

 

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