Automated World Health
L29194 INCISION AND DRAINAGE OF ABSCESS OF SKIN, SUBCUTANEOUS
AND ACCESSORY STRUCTURES
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 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.
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
• 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).
• 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.
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.