No, procedure codes CPT 10060 and 10061 represent incision and drainage CPT of an abscess involving the skin, subcutaneous and/or accessory structures. Therefore, the medical necessity diagnosis code must represent an abscess, not the underlying condition causing the abscess. For example, the ICD-9-CM code for sebaceous cyst (706.2) would not meet medical necessity for procedure codes CPT 10060 or CPT 10061. If the patient had an abscess of a sebaceous cyst then it would be appropriate to code the applicable ICD-9-CM code for the abscess (depending upon the anatomical location of the abscess).
Similarly, if billing a covered diagnosis, the medical record must demonstrate that an abscess was present. For example, if billing the diagnosis code for paronychia of the toe (ICD-9-CM code 681.11), the medical record must clearly demonstrate that an abscessed paronychia was present and that incision and drainage of the purulent material occurred, in order to bill procedure code CPT 10060 or CPT 10061. If a nail avulsion occurred and the medical record documentation does not demonstrate that an abscess was present and incision and drainage of purulent material occurred, then the appropriate nail avulsion procedure code (CPT 11730 or CPT 11732) should be billed, not procedure codes CPT 10060 or CPT 10061.
Furthermore, there are many other anatomical sites of abscess that are not addressed in this policy. There are numerous incision and drainage procedure codes that are specific to the incisions and drainage of an abscess in various anatomical sites. Therefore, it would be appropriate to bill these more specific incision and drainage codes. For example: an abscess of the eyelid should be billed with procedure code CPT 67700 (Blepharotomy, drainage of abscess, eyelid); a perirectal abscess should be billed with procedure code CPT 46040 (Incision and drainage of ischiorectal and/or perirectal abscess); an abscess of the finger should be billed with procedure codes CPT 26010-26011 (Drainage of finger abscess).