How To Use CPT Code 22015

CPT code 22015 describes the incision and drainage of a deep abscess in the posterior spine, specifically in the lumbar, sacral, or lumbosacral region. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 22015?

CPT code 22015 is used to describe the surgical procedure of incision and drainage for a deep abscess in the posterior spine. This code specifically applies to abscesses located in the lumbar, sacral, or lumbosacral region. The purpose of this procedure is to relieve pain and pressure caused by the abscess.

2. Official Description

The official description of CPT code 22015 is: ‘Incision and drainage, open, of deep abscess (subfascial), posterior spine lumbar, sacral, or lumbosacral.’

3. Procedure

During the procedure described by CPT code 22015, the healthcare provider makes an incision in the skin over the abscess in the posterior spine. They then dissect through the soft tissue and superficial fascia until they reach the deep fascia adjacent to the muscle layer. The provider carefully removes any necrotic or dead tissue and purulent material or pus. The area is then irrigated, and a drainage tube may be inserted. The provider checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT code 22015 is applicable when there is a deep abscess in the posterior spine, specifically in the lumbar, sacral, or lumbosacral region. The abscess must be subfascial, meaning it is located below the deep fascia and adjacent to muscles, bones, nerves, or blood vessels. It is important to note that CPT code 22015 should not be reported in conjunction with code 22010, which is used for abscesses in the cervical, thoracic, or cervicothoracic spine. Additionally, code 22015 should not be reported with codes 10180, 22850, or 22852, which are used for instrumentation removal.

5. When to use CPT code 22015

CPT code 22015 should be used when a healthcare provider performs an incision and drainage procedure on a deep abscess in the posterior spine, specifically in the lumbar, sacral, or lumbosacral region. It is important to ensure that the procedure is not performed on the cervical, thoracic, or cervicothoracic spine, as a different code (22010) should be used in those cases.

6. Documentation requirements

To support a claim for CPT code 22015, the healthcare provider must document the following information:

  • Patient’s diagnosis and the presence of a deep abscess in the posterior spine
  • Details of the procedure, including the incision, drainage, debridement, irrigation, and insertion of a drainage tube
  • Date of the procedure
  • Start and end time of the procedure
  • Any complications or additional procedures performed
  • Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 22015, ensure that the procedure is performed on the lumbar, sacral, or lumbosacral region of the posterior spine. Do not report code 22015 in conjunction with code 22010 or codes 10180, 22850, or 22852. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary.

8. Historical information

CPT code 22015 was added to the Current Procedural Terminology system on January 1, 2006. Since its addition, there have been several changes related to Medicare coverage. In 2017, it was added to the Inpatient Only (IPO) list, but in 2021, it was removed from the IPO list. However, in 2022, it was added back to the IPO list.

9. Similar codes to CPT code 22015

There are several similar codes to CPT code 22015 that are used for different regions of the spine and different types of abscesses. These codes include:

  • CPT 22010: Incision and drainage, open, of deep abscess (subfascial), posterior spine cervical, thoracic, or cervicothoracic
  • CPT 10060: Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single
  • CPT 10140: Incision and drainage of hematoma, seroma or fluid collection
  • CPT 22016: Incision and drainage, open, of deep abscess (subfascial), posterior spine cervical, thoracic, or cervicothoracic; complicated
  • CPT 22017: Incision and drainage, open, of deep abscess (subfascial), posterior spine cervical, thoracic, or cervicothoracic; infected

9. Examples

  1. A patient presents with a deep abscess in the lumbar region of the posterior spine. The healthcare provider performs an incision and drainage procedure using CPT code 22015.
  2. A patient is diagnosed with a subfascial abscess in the sacral region of the posterior spine. The healthcare provider performs an incision and drainage procedure using CPT code 22015.
  3. A patient undergoes an incision and drainage procedure for a deep abscess in the lumbosacral region of the posterior spine. CPT code 22015 is used to report the procedure.
  4. A healthcare provider performs an incision and drainage procedure on a deep abscess in the lumbar region of the posterior spine. CPT code 22015 is used to bill for the procedure.
  5. A patient presents with a subfascial abscess in the sacral region of the posterior spine. The healthcare provider performs an incision and drainage procedure using CPT code 22015.

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