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Basics about CPT code for Incision and Drainage 10060 & 10061

CPT codebook consist all the codes used for different facilities. We have lot of percutaneous procedures like fine needle aspiration, breast biopsy, nephrostogram, cholangiogram, bone marrow biopsy etc. Today, we will try to learn about coding incision and drainage procedure in surgery. CPT code 10060 is used for incision and drainage of a simple or single abscess. Simple lesions are typically left open to drain and heal by secondary intention. And use CPT code 10061 for incision and drainage of a complicated or multiple abscesses. Complicated abscesses require placement of drain or packing.

For percutaneous procedures, you can learn first about coding imaging guidance codes 76942, 76937, 77001, 77002, 77003 etc.

Description of CPT code 10060 & 10061 (incision and drainage)

An abscess is a collection of pus of any size which can be present in any location of the body and can lead to infection if not taken care. Their are certain sign and symptoms like redness, warmth, tenderness, fluctuance, edema, lymphangitis.

Any lesion not having such signs or symptoms and has no presence of pus or infected purulent fluid, then it does not qualify for abscess. Such lesion may be hematoma, seroma, bulla or cyst, which may be treated using incision and drainage.

Their can be simple and complicate abscess depending on the severity. Simple abscess can be treated using a single puncture or incision. A complicated abscess with infection and necrosis takes a little more time an effort to treat. Even a locally injected anesthesia may be used to treat the complicated abscess to resolve the infection smoothly. Medical coders used specific codes for simple and complex abscess procedures.

CPT code 10060 is reported for incision and drainage of a simple or single abscess.Below the description.

10060– Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

CPT code 10061 for incision and drainage of a complicated or multiple abscesses. Simple lesions are typically left open to drain and heal by secondary intention. If packing is placed, it is usually left in for 1-2 days.

10061 – Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple

Supply Code for CPT code 10060

SA048 pack, minimum multi-specialty visit
SB011 drape, sterile, fenestrated 16in x 29in
SB024 gloves, sterile
SB033 mask, surgical
SC029 needle, 18-27g
SC058 syringe w-needle, OSHA compliant (SafetyGlide)
SF033 scalpel with blade, surgical (#10-20)
SG017 bandage, Kling, non-sterile 2in
SG034 dressing, 3in x 3in (Adaptic)
SG054 gauze, sterile 3in x 3in
SH046 lidocaine 1% w-epi inj (Xylocaine w-epi)
SJ025 ethyl chloride spray
SJ028 hydrogen peroxide
SJ041 povidone soln (Betadine)
SJ053 swab-pad, alcohol

Supply codes for CPT code 10061

SA048 pack, minimum multi-specialty visit
SB007 drape, sterile barrier 16in x 29in
SB011 drape, sterile, fenestrated 16in x 29in
SB024 gloves, sterile
SB027 gown, staff, impervious
SB033 mask, surgical
SC031 needle, 30g
SC064 syringe-needle 3ml 22-26g
SF033 scalpel with blade, surgical (#10-20)
SG017 bandage, Kling, non-sterile 2in
SG035 dressing, 3in x 4in (Telfa, Release)
SG054 gauze, sterile 3in x 3in
SG055 gauze, sterile 4in x 4in
SG056 gauze, sterile 4in x 4in (10 pack uou)
SG062 packing, gauze plain 0.25-0.50in (5 yd uou)
SH046 lidocaine 1% w-epi inj (Xylocaine w-epi)
SJ028 hydrogen peroxide
SJ041 povidone soln (Betadine)
SJ046 silver nitrate applicator
SJ053 swab-pad, alcohol

When to use CPT code for Incision and Drainage 10080 & 10081

Their are specific codes for incision and drainage of pilonidal cyst. Pilonidal cyst is located above the cleft of the buttocks and typically contains hair and skin debris. When the cyst becomes infected and form abscess , an incision and drainage is performed to treat the cyst.

It is simple incision but needs a complex treatment. The skin and cleansed and local anesthesia is given for removal of infected fluid. In this exam, the elliptical incision is made and the pockets of pus are opened using blunt dissection. The infected abscess in removed along with hair and debris along the epithelial lining using curettage.

CPT code 10080 is used for a simple incision and drainage with local wound care to facilitate healing. And CPT code 10081 for a complicated incision and drainage which includes placement of a drain or packing with gauze.

10080 – Incision and drainage of pilonidal cyst; simple

Supply codes for CPT code 10080

SA048 pack, minimum multi-specialty visit
SA052 pack, post-op incision care (staple)
SB001 cap, surgical
SB007 drape, sterile barrier 16in x 29in
SB012 drape, sterile, for Mayo stand
SB016 drape-cover, sterile, OR light handle
SB019 drape-towel, sterile 18in x 26in
SB024 gloves, sterile
SB027 gown, staff, impervious
SB034 mask, surgical, with face shield
SB044 underpad 2ft x 3ft (Chux)
SC001 angiocatheter 14g-24g
SC029 needle, 18-27g
SC051 syringe 10-12ml
SF033 scalpel with blade, surgical (#10-20)
SF036 suture, nylon, 3-0 to 6-0, c
SF040 suture, vicryl, 3-0 to 6-0, p, ps
SG033 dressing, 12-7mm (Gelfoam)
SG056 gauze, sterile 4in x 4in (10 pack uou)
SG079 tape, surgical paper 1in (Micropore)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH074 water, sterile for irrigation (250-1000ml uou)
SJ009 basin, irrigation
SJ010 basin, emesis
SJ011 bulb syringe (Asepto)
SJ041 povidone soln (Betadine)
SJ046 silver nitrate applicator
SJ053 swab-pad, alcohol
SL035 cup, biopsy-specimen non-sterile 4oz
SM023 scrub brush (impregnated)

10081 – Incision and drainage of pilonidal cyst; complicated

Supply codes for CPT code 10081

SA048 pack, minimum multi-specialty visit
SA052 pack, post-op incision care (staple)
SB001 cap, surgical
SB007 drape, sterile barrier 16in x 29in
SB012 drape, sterile, for Mayo stand
SB016 drape-cover, sterile, OR light handle
SB019 drape-towel, sterile 18in x 26in
SB024 gloves, sterile
SB027 gown, staff, impervious
SB034 mask, surgical, with face shield
SB044 underpad 2ft x 3ft (Chux)
SC001 angiocatheter 14g-24g
SC029 needle, 18-27g
SC051 syringe 10-12ml
SD009 canister, suction
SD132 tubing, suction, non-latex (6ft uou)
SD134 tubing, suction, non-latex (6ft) with Yankauer tip (1)
SF016 cautery, monopolar, electrode tip
SF033 scalpel with blade, surgical (#10-20)
SF036 suture, nylon, 3-0 to 6-0, c
SF040 suture, vicryl, 3-0 to 6-0, p, ps
SG033 dressing, 12-7mm (Gelfoam)
SG056 gauze, sterile 4in x 4in (10 pack uou)
SG079 tape, surgical paper 1in (Micropore)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH074 water, sterile for irrigation (250-1000ml uou)
SJ009 basin, irrigation
SJ010 basin, emesis
SJ011 bulb syringe (Asepto)
SJ041 povidone soln (Betadine)
SJ053 swab-pad, alcohol
SL035 cup, biopsy-specimen non-sterile 4oz
SM023 scrub brush (impregnated)

For percutaneous aspiration of abscess, hematoma, bulla or cyst, procedure code 10160 is used. While coding CPT code 10160, also use the imaging guidance procedure code 76942, 77002, 77012, 77021 along with these procedures.

10160 – Puncture aspiration of abscess, hematoma, bulla, or cyst

For reporting code 10160, the physician performs a puncture aspiration of an abscess, hematoma, bulla, or cyst. The palpable collection of fluid is located subcutaneously. The physician cleanses the overlying skin and introduces a large bore needle on a syringe into the fluid space. The fluid is aspirated into the syringe, decompressing the fluid space. A pressure dressing may be placed over the site.

According to UnitedHealthcare, this code may have a limit of 3 maximum frequency per day, please consult your payer.

RVUs and Fees of 10060 CPT code

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	1.22	0.12	2.42	3.76	$127.42
Facility	Work	MP	PE	RVU	Total
Facility	1.22	0.12	1.80	3.14	$106.41

RVUs and Fees of 10061 CPT code

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	2.45	0.30	3.62	6.37	$215.86
Facility	Work	MP	PE	RVU	Total
Facility	2.45	0.30	2.72	5.47	$185.36

RVUs and Fees of 10080 CPT code

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	1.22	0.19	6.17	7.58	$256.86
Facility	Work	MP	PE	RVU	Total
Facility	1.22	0.19	1.71	3.12	$105.73

RVUs and Fees of 10081 CPT code

Non-Facility	Work	MP	PE	RVU	Total
Non-Facility	2.50	0.44	7.41	10.35	$350.73
Facility	Work	MP	PE	RVU	Total
Facility	2.50	0.44	2.16	5.10	$172.82

Coding tips for CPT code 10060 & 10061 (incision and drainage)

When coding I&D of a hematoma, seroma or fluid collection of the skin, reference code 10140. For I&D of a post-operative wound, complicated, reference code 10180. These codes would be reported instead of codes 10060-10061.
When excision, destruction, repair or removal of a lesion involves drainage for access to the surgical site, the incision and drainage done at the same session and site is not coded.
If tissue is removed, use CPT code 11770-11772.
When excision, destruction, repair or removal of a lesion involves drainage for access to the surgical site, the incision and drainage done at the same session and site is not coded.
For code 10081, “complicated” is a discretionary judgment of the physician.
The documentation should show that both incision and drainage of an abscess were performed and that multiple incisions were made. Medicare considers the abscess “complicated” if multiple incisions were made.

Additional Code Information for CPT code 10060,10061,10080 & 10081

PC/TC Indicator (26): 0 = Physician Service Codes

Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply

Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 1 = Statutory payment restriction for assistants at surgery applies to this procedure

Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure

Team Surgery (66): 0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family: 99 = Concept does not apply

FAQ

CPT code 10060 vs 10140?

Integumentary codes for I&D are chosen based on the type of defect (eg, foreign body, pilonidal cyst, abscess, hematoma) and whether the physician has documented that the procedure was complicated. Based on this we should report 10060 or 10140 as per the documentation. Below is the description for CPT code 10140.

10140 – “Incision and drainage (I&D) of hematoma, seroma or fluid collection”

CPT code 10060 vs 26010?

20610 – Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance

In this exam, the needle penetrates the joint capsule or bursa, and fluid within is withdrawn. Codes for arthrocentesis are based on the size of the targeted joint or bursa.

CPT code 20610 is performed on joints specifically while code 10060 is not site specific. Also, code 20610 does not need incision for performing arthrocentesis while code 10060 is an Incision and drainage exam. Both are very different from each other.

Also 20610 has NCCI edit with CPT code 10060, to code both procedure together, 1006o need to be assigned with 59 or X-modifier to bypass the edit, since 20610 is a comprehensive procedure code.

CPT code 56405 vs 10060?

56405 – Incision and drainage of vulva or perineal abscess

CPT code 56405 is site specific abscess code while 10060 is not site specific. When their is no site specific code for abscess CPT code 10060 is the best option to code for I&D abscess exam.

CPT code 19020 vs 10060?

19020 – Mastotomy with exploration or drainage of abscess,deep

CPT code 19020 is site specific abscess code while 10060 is not site specific. When their is no site specific code for abscess CPT code 10060 is the best option to code for I&D abscess exam.

References:
https://www.todayshospitalist.com/tips-to-choose-the-right-codes-for-
https://www.aapc.com/blog/34676-superficial-incision
http://www.eatonhand.com/coding

One Thought to “CPT code 10060, 10061, 10080 & 10081: Incision and Drainage Coding”

Nichole
August 11, 2021 at 5:56 am
Hello. Do you have any info about whether HEDIS code say 4025f can be used as long as the patients med list is in the encounter even if it was not addressed in the assessment and plan?