Query: Coding an I&D + Delayed Closure
How would you code the following? Procedure:
Incision and drainage
of deep abscess of the 1st metatarsal-phalangeal
joint. The incision
was made through the subcutaneous tissue through
and to the level of
the extensor hallucis longus tendon and 1st
metatarsal-phalangeal
joint capsule. Purulence was expressed and
drained from the deeper
aspects of the 1st intermetatarsal space.
Three days later, under local anesthesia (Mayo
block) with light IV
sedation, a delayed closure was performed on the
patient (the wound
site was no longer draining). How would the
delayed closure be
coded?
Michele Galarneaux, Portland, OR
Response: The information you provided notes
that the incision and
drainage was a deep abscess in the 1st
intermetatarsal space of the
foot (although the procedure listed was an I&D
of the 1st metatarsal-
phalangeal joint). Assuming the intermetatarsal
space was, indeed,
the area in which the I&D was performed, I would
recommend the
following:
CPT 28002 - incision and drainage below fascia,
with or without
tendon sheath involvement, foot; single bursal
space. This has a 10-
day Medicare global period assigned.
[NOTE: If the I&D involved more than the 1st
intermetatarsal space
(i.e., also the 1st metatarsal-phalangeal joint
or another deep
space), then you could consider coding, instead,
the bundle of deep
I&D procedures as CPT 28003 which has a 90-day
Medicare global
period assigned]
If you had expected to perform a delayed closure
on the patient (and
it was reasonable and necessary to do so in
light of the previous
presence of a deep abscess), you would use CPT
12020 (treatment of
superficial wound dehiscence; simple closure)
which is used for
simple secondary closure of a surgical wound. Be
sure to append a "-
58" modifier to the code to indicate a stage
procedure (and allow
for independent reimbursement). You would not be
additionally
reimbursed for the surgical anesthetic block
administered.
[Your description (below) did not evidence that
the delayed closure
was either extensive or complicated, so you
would NOT code the
closure using CPT 13160]
Harry Goldsmith, DPM, Cerritos, CA
