CPT 10060 and CPT 10061 represent incision and drainage CPT of an abscess involving the skin, subcutaneous and/or accessory structures.
Description of CPT 10061: Incision of a drainage of abscess (e.g. carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia), complicated or multiple.
Description of CPT 10060: Incision of a drainage of abscess (e.g. carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia), simple or single.
Coding Guidelines For CPT 10060 & CPT 10061
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 10 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 & CPT 26011 (Drainage of finger abscess).