This page addresses follow-up questions and additional information pertinent to our webinar
Coding Integumentary Procedures Performed in the Emergency Department.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q) If an ultrasound is needed to perform an incision and drainage procedure, can both services be reported?
A) Incision and drainage codes do not include use of an ultrasound. The ultrasound may be reported separately. Ensure that the retrievable permanent images are stored in the medical record and the ultrasound findings are documented. Use modifier 26 on the ultrasound to indicate the professional interpretation.
Q) If the laceration procedure note states the closure was done by mattress suture technique, will that alone support an intermediate repair code?
A) Mattress sutures do not automatically mean intermediate repair. Mattress sutures are a stitching technique and the simple vs intermediate repair CPT codes are based on layers. It is possible that the mattress sutures could be a layered closure, but the documentation must be clear about which layers are closed. Statements of mattress sutures alone will not support intermediate.
Q) Can a full nail avulsion (11730) and matrix excision (11750) be reported for the same nail? The provider first removes the nail, which is the avulsion, and then cauterizes the matrix. Both procedures are fully performed.
A) You cannot bill for both codes on the same finger. Code 11750 for the matrix excision includes the avulsion, 11730. If these procedures are performed on two separate fingers, or toes, then both procedures may be reported with appropriate modifiers. We recommend including the anatomical modifiers to support the two codes being reported together.
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Meet the Presenter: Emily Lomaquahu, CPC, CPMA, CEDC
Emily is a Senior Coding Quality Auditor for Haugen Consulting Group and brings over a decade of experience to the profee team! She began her career as an auditor and with her keen eye for detail, she quickly found it was a perfect fit. Emily thrives in a collaborative environment and enjoys creating high-quality trainings to help providers and coders navigate charts and improve their accuracy. She earned a bachelor’s degree from the University of Colorado, in Denver. Emily specializes in Evaluation and Management (E/M), Primary Care, Anesthesia, Emergency Department, and Neurology, though she says Anesthesia and Neurology are her favorites! She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), and Certified Emergency Department Coder (CEDC).
I have a question in regard to the guidance for CPT 10061 on slide 14. What references were used to determine that those procedures listed in the slide are considered complex?
HCPCS coding clinic from 2nd Qtr, 2017 states we should query the physician if the documentation doesn’t state simple or complex, and not to code it based on if a drain or packing was used.
CPT Assistant December 2006, also states the decision for normal vs complication is at the physician’s discretion. Does this mean the physician needs to state it was complicated in order to code 10061?
After reviewing the referenced Coding Clinic guidance, we understand the question surrounding what qualifies an incision and drainage (I&D) procedure as complicated and whether the provider must explicitly document the procedure as “complex.”
The Coding Clinic response does not indicate that providers are required to use the specific terms “simple” or “complex.” Rather, it emphasizes that coders should avoid making assumptions when the documentation does not clearly support a complicated I&D.
At this time, there is no definitive, black and white rule for reporting code 10061. Its use is ultimately at the provider’s discretion, provided the documentation clearly supports why the procedure was more complicated than a simple I&D. Our recommendations on the use of 10061 are informed by a review of multiple sources, including AAPC guidance, CPT Assistant, and other established coding references.
Some facilities or provider groups may also develop internal policies based on their preferences for supporting the use of 10061.