CPT 10060

CPT 10060 (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

CPT 10060 is used for superficial or single abscesses. Shallow lesions are mostly left open to drain and heal by secondary intention. Complicated abscesses require placement of drain and packing. Use CPT code 10060 for incision and drainage of complicated or multiple abscesses.

CPT 10060 Description

There are a lot of percutaneous procedures like fine-needle aspiration, bone marrow biopsy, nephrostogram, breast biopsy, etc.

Incision and drainage are extensively used in different care settings, including outpatient clinics and inpatient and emergency departments. It is the principal treatment for skin and soft tissue abscesses, with or without ancillary antibacterial therapy.

For percutaneous procedures, you need to learn about imaging guidance codes 76942, 77001, 77002, etc.; incisions and drainage procedures are often done with imaging guidance.

I&D of abscess or bump (e.g., cluster of boils, painful lumps under the skin, cutaneous or subcutaneous pus, cyst, furuncle, or nail inflammation); simple or single.

Cutaneous abscesses are localized pus collections within the dermis and subcutaneous space. They appear virtually anywhere on the body; however, common locations for a bump to develop are the groin, buttocks, axillae, and extremities.

In most cases, physical examination alone is for diagnosing a cutaneous abscess. The classic signs of a bump(Abscess) are erythema, induration, tenderness to palpation, and fluctuance. In addition, one must take care to differentiate between cellulitis and abscess, as the treatment for cellulitis is antibiotic therapy without drainage.

Most patients with an abscess should have an Incision and drainage performed, as antibiotic therapy alone is insufficient for treatment.

cpt code 10060

Coding Tips:

Local anesthesia is included in this CPT 10060 service. For puncture aspiration of an abscess, hematoma, bulla, or cyst, use 10061. For I&D of a pilonidal cyst, simple, use 10080; complicated, use 10081. My report supplies the appropriate HCPCS Level II code for physician offices. Check with the specific payer to determine coverage.

Procedure codes 10060 represent I&D of an abscess or cyst, including the skin, subcutaneous tissues, or relative structures. Thus, the medical necessity diagnosis code must represent an abscess or cyst, not the underlying condition causing the bump.

For Example, the ICD 10 CM code for sebaceous cysts would not fulfill the medical necessity for CPT code 10060. It would be more suitable to code the applicable ICD 10 CM code for the abscess (depending upon the anatomical location of the bump) if the patient had a blemish of a sebaceous cyst, 

Documentation Tip:

Documentation should include the anatomical location of the abscess and the size, placement of drainage, or complicating factors.

Maintained all documentation in the patient’s medical record and made it available to the contractor upon request.

Every record page must include appropriate patient identification information and be legible (e.g., name, date of service). In addition, the documentation must include the legible signature of the physician or non-physician practitioner responsible for providing care to the patient.

The CPT/HCPCS code must define the service performed.

The submitted medical record must support the selected ICD 10 CM code. 

The medical record must indicate that an abscess was present, including the abscess’s location, size, and appearance. 

In addition, if frequent incisions and drainage are required, the medical record must reflect the reason for persistent/recurrent abscess formation and measures to avoid reoccurrence. 

CPT 10060 Reimbursement

Because 10061 indicates multiple incisions and drainage procedures, we should report this service only with a unit of 1 displayed on the CMS 1500 claim form, regardless of the number of times the service is performed.

Must fulfill Medical necessity for CPT 10060. Medical necessity or ICD 10 Codes should always support the CPT Codes to get paid from this payer or insurance companies.

When you code CPT 10060 with an initial or subsequent hospital visit code, you must modify the E&M code with modifier 25 to indicate that the service is different. 

When billing services that are requested by the beneficiary for denial that is regulatory not accepted by Medicare (i.e., Routine foot care), report an ICD 10 code that best describes the patient’s condition and adds the GY modifier ( services or items statutorily excluded or does not meet the definition of any Medicare benefit).

CPT 10060 Billing Guidelines

According to new billing guidelines, only one unit per visit of CPT 10060 is allowed to be billed.

Cost and Relative value units of the facility services:

The Cost and total RVUs of CPT 10060 are $106.59 and 3.08000

respectively for both National and Global Facility Services.

Cost and Relative value units of the Non-facility services:

The Cost and total RVUs of CPT 10060 are $127.70 and 3.69000

respectively for both National and Global Non-Facility Services.

Facility codes reflect the volume and ferocity of resources used by the facility to provide care.

It is not suitable to bill Medicare for non-covered services. Always use the appropriate modifier when billing for non-covered services.

CPT 10060 represents the abscess’s incision and drainage involving the subcutaneous tissues, skin, and accessory structures. So, the medical necessity diagnosis code must mean a bump, not the underlying condition causing the abscess.

For Example, the ICD 10 CM code for sebaceous cysts would not meet medical necessity for procedure codes 10060 or 10061.

However, if the patient had a bump of a sebaceous cyst, then it would be appropriate to code the applicable ICD 10 CM code for the abscess (depending upon the anatomical location of the node). 

The provider’s responsibility is to select codes carried out to the highest level of specificity and chosen from the ICD 10 CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

CPT 10060 Modifiers

Modifiers provide additional information about the medical procedure, service, or supply involved without changing the meaning of the code.

Modifiers that are applicable with CPT 10060 are given below:

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, E1, E2, E3, E4, ET, EY, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, T1, T2, T3, T4, T5, T6, T7, T8, T9, TA, XE, XP, XS, XU.

Modifiers often used in medical coding and billing for CPT 10060 are 51, 59, 76, 77, 78, 79, E1, E2, E3, E4, ET, EY, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, KX, T1, T2, T3, T4, T5, T6, T7, T8, T9, TA.

Modifier Tips:

Here are some essential modifiers tips for CPT 10060.

E and F series modifiers are reported for procedures done on fingers and toes. Every modifier has a separate description depending upon the area of treatment. For example:

E1—Upper left eyelid

E4—Lower right, eyelid

F5—Right hand, thumb

F8—Right hand, fourth digit

FA—Left hand, thumb

T4—Left foot, fifth digit

TA—Left foot, great toe

Modifier 51 with Example

Multiple procedures: More than one procedure is performed at the same provider’s session. 

Not used on E&M services, Add-on codes.

Example:

The dermatologist performs incision & drainage at the big toe, and after that, he performs an excision of a lesion on the chest. So, in this case, the Big toe incision and drainage and chest lesion excision are two different but have no conflict, so append modifier 51 with one procedure.

Modifier 59 with Example

Distinct procedural services—Under specific circumstances, it is necessary to specify that a service or procedure was separate from other non-Evaluation and Management services provided on the same day.

Modifier 59 is used to determine benefits, other than E&M services, that are not reported together but are appropriate under different circumstances. 

Documentation must support a different site or organ system, extra session, other procedure or surgery, separate lesion, separate incision or excision, or separate area of injury not ordinarily encountered on the same day by the same person. 

If no more descriptive modifier is available, the use of modifier 59 best explains the circumstances.

Example:

CPT 10060 procedures and 11721 were performed on the same day. However, both CPTs have different descriptions and are distinct from each other. So, In this case, append modifier 59 to CPT 11721 because of low RVUs.

Modifier 76 with Example

Repeated procedure Done by the Same Physician or Other Qualified Health Care Professional.

It is essential to indicate that a service was repeated by the same physician or other qualified health care professional following the original procedure. In this case, append modifier 76 to identify it as a repeated procedure.

Example:

A doctor performed procedure CPT code 10060 on the big toe, the patient returned after two days to remove more abscesses, and the same procedure was performed again by the doctor. In this case, append modifier 76 with one CPT 10060.

Modifier 77 with Example

Procedure Repeated by Another Physician or Other Qualified Health Care Professional.

It is necessary to indicate that a procedure was repeated by another physician or other qualified health care professional following the original method or service. May report this by adding modifier 77 to the repeated treatment procedure.

Example:

Physician X performed an incision and drainage at the 4th digit of the foot in the afternoon, and another physician repeated the service to remove more pus in the evening. Use modifier 77 with one CPT. 

Modifier 78 with Example

An Unplanned Patient returned to the operating room and was treated by the same Initial physician, and the same procedure was done during the Postoperative Period.

Example:

Patient brought to recovery room status post-surgery. Dressings became saturated; vital signs were unstable. The patient was carried back to the operation theatre to explore postoperative hemorrhage. 

Modifier 79 with Example:

An Unplanned Patient returned to the operating room for treatment of an unrelated condition by the same physician, and the same procedure was done during the Postoperative Period.

The individual needs to indicate that the performance of a procedure or service during the postoperative period was unrelated to the previous service. In these circumstances, append modifier 79 with the previously done service.

Example:

A Doctor performed cataract removal of the right eye on 27th April 2022. On 23rd May, the same physician performed an Incision and drainage of the left 4th digit of the foot. So, in this case, append modifier 79 to the unrelated procedure performed within the global fee period.

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