CPT code 10061 in CPT Coding Questions Forum

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CPT code 10061

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vballmom	CPT code 10061	Lead	[-]
Posts: 4 Apr 29 10 7:49 AM Reply Quote More My Recent Posts	Tags : None My doctor did an I & D on 9 abcesses, do I bill 10061 once to include all even if they were on differents sites? We initially billed 10060-59 for each site which was denied for duplicate.
mbrown555		#1	[-]
Posts: 837 Apr 29 10 9:25 AM Reply Quote More My Recent Posts	Did you bill 10060 for the first (single or simple) and 10061 on each addtl (? You would use modifier 59 if the locations were distinct. I included CMS Proper Use of Modifier 59 article. http://www.cms.gov/MLNMattersArticles/downloads/SE0715.pdf http://oig.hhs.gov/oei/reports/oei-03-02-00771.pdf If the anatomoical sites, locations, etc. were indeed separate, it is very important to have that information document in your medical chart. It would be appropriate to bill with separate diagnosis codes, if necessary, in order to specify anatomical sites. 10060 x 1 - 682.0 10061 x 1 - 682.4 10061-59 x 4 - 682.2, etc. The more specific you can be with your diagnosis codes the better. You would use modifier 59 on each addtl 10061 after the initial one. Also, if you can use LT (left) & RT (right) with the sides of the body to help be more specific the better the chances are of getting your claim paid. You would bill it with the numerical modifier 1st and the alpha modifier 2nd. Hope that helps! Melinda Brown, CMBS Ins Biller
vballmom		#2	[-]
Posts: 4 Apr 29 10 10:50 AM Reply Quote More My Recent Posts	Patient had an abscess on his Rt and Lt thigh, Rt and Lt shoulder, Lt wrist, Lt ring finger, Rt index finger and 2 on his Rt forearm. My coder suggested 10060 for the first one, 10060-59 for all the rest except the 2 on the Rt forearm, because they are on the same site 10061. This didn't sound right to me.
mbrown555		#3	[-]
Posts: 837 Apr 29 10 12:49 PM Reply Quote More My Recent Posts	Scratch my 10061 comment...I was thinking of excision codes / lesions and not I&D. Sorry! I pulled out my CPT book and read the descriptons for 10060 & 10061. 10060 if they were "simple or single" and use the 10061 if they were complicated or multiple". Your coder is correct. Unless they are "complicated or multiple" and then use the 10061. Only your chart note / provider will be able to tell you which to use. Whichever codes you end up using, be sure to report the 59 on the 2nd procedure and subsequent codes. I'd also use the RT & LT along with the different body locations (ICD-9 codes) to distinguish that they were "distinct" and separate locations / anatomical sites. And most importantly, make sure your medical records reflects documentation for the procedure code depending on whether is is "simple or complicated." Here's an article I found: http://www.skinandaging.com/article/3648 Q: When I incise and drain an infected cyst, I usually use CPT code 10060 (incision and drainage of abscess — e.g., carbuncle, suppurativa hidrandenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia — simple or single). I never use CPT code 10061 (which states “complicated or multiple”). When actually do I use CPT code 10061 and what makes a cyst I&D complicated? A: Here again is an example where CPT started the race, but never finished. Clearly, it’s not difficult to make the distinction between single and multiple. Differentiating between simple and complicated, however, is another matter. I have found nothing formally published by the American Medical Association that provides any insight into the distinction between the two. I have always advised physicians and coders to consider several criteria; the most important being the insertion of a drain or gauze that would require a follow-up visit within the ten day post-op period. Obviously, the insertion of a drain or gauze would indicate that the treatment of the lesion is not simple, but requires more effort, skill, and supplies. Additionally, the need for another visit within the global period is also required for drain removal and wound care assessment. Other criteria could include infection, the size of the lesion, the need for culturing and, complexity of the dressing. The combination of any of these may substantiate the use of the more complicated code although there is nothing formally written on this subject. It’s anyone’s guess what some auditor from some managed care plan or Medicare thinks is the appropriate use of CPT code 10061. At least you’ll have some ammunition if your documentation describes a more complex procedure. Although the postoperative time frames are the same (ten days for both codes 10060 and 10061), payment is significantly more for code 10061 (which I feel confident reflects the extra work and added office visit). Using Medicare’s 2005 allowables for Participating Physicians, you can see the difference in payment for CPT code 10060 at $94.74 versus 10061 at $169.78. A final comment, whether you choose CPT codes 10060 or 10061, you cannot bill any visits during the postoperative period that are related to the treated lesion(s). http://www.hraorg.com/articles/MAY05.pdf Note that even if the incisions in this procedure are simple, you can list the procedure as complex if you perform more than one incision.

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