How To Use CPT Code 26990

CPT 26990 describes the procedure of incision and drainage for a deep abscess or hematoma in the pelvis or hip joint area. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26990?

CPT 26990 can be used to describe the incision and drainage procedure performed by a healthcare provider to treat a deep abscess or hematoma in the pelvis or hip joint area. This code is used when the provider makes an incision, drains the pus or blood clot, and flushes the area to promote healing and prevent further complications.

2. Official Description

The official description of CPT code 26990 is: ‘Incision and drainage, pelvis or hip joint area; deep abscess or hematoma.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring proper anesthesia and sterilization.
2. The provider makes an incision in the skin and continues through the deep subcutaneous tissues to expose the abscess or hematoma.
3. If necessary, the incision may be extended further to fully expose the abscess or hematoma.
4. The provider drains the pus or blood clot using a syringe or catheter.
5. If a hematoma is present, the provider removes the blood clots.
6. The area is thoroughly flushed with a saline solution to clean and promote healing.
7. The provider closes the incision by suturing the layers of tissue together or leaves it open for further drainage.

4. Qualifying circumstances

CPT 26990 is used when a patient has a deep abscess or hematoma in the pelvis or hip joint area that requires incision and drainage. The procedure is performed by a healthcare provider who is trained and qualified to perform such interventions. The patient must be appropriately prepped and anesthetized for the procedure.

5. When to use CPT code 26990

CPT code 26990 should be used when a healthcare provider performs the incision and drainage procedure for a deep abscess or hematoma in the pelvis or hip joint area. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 26990, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the presence of a deep abscess or hematoma in the pelvis or hip joint area
• Details of the procedure, including the size and location of the incision, drainage method used, and any additional steps taken
• Use of anesthesia and patient preparation
• Flush solution used for cleaning the area
• Method of wound closure, whether sutures or leaving the incision open
• Any complications or follow-up care required
• Provider’s signature and credentials

7. Billing guidelines

When billing for CPT 26990, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately report the procedure performed and provide appropriate documentation to support the claim. Additionally, be aware of any specific guidelines or modifiers that may apply to the billing of this code.

8. Historical information

CPT 26990 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs an incision and drainage procedure for a deep abscess in the pelvis of a patient.
2. A patient presents with a hematoma in the hip joint area, and the provider performs an incision and drainage to remove the blood clot.
3. A healthcare provider treats a deep abscess in the pelvis of a patient by making an incision and draining the pus.
4. A patient undergoes an incision and drainage procedure for a deep abscess in the hip joint area.
5. A healthcare provider performs an incision and drainage procedure for a hematoma in the pelvis of a patient.
6. A patient with a deep abscess in the hip joint area undergoes an incision and drainage procedure to remove the pus.
7. A healthcare provider treats a hematoma in the pelvis of a patient by making an incision and draining the blood clot.
8. A patient presents with a deep abscess in the hip joint area, and the provider performs an incision and drainage to remove the pus.
9. A healthcare provider performs an incision and drainage procedure for a deep abscess in the pelvis of a patient.
10. A patient undergoes an incision and drainage procedure for a hematoma in the hip joint area.