Author Topic: 10061  (Read 13920 times)

bliss

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10061
« on: May 01, 2010, 10:01:39 PM »
Can anyone explain if 10060, or 10061, And if these codes can have units billed, and what exactly is would you consider the definition of a unit is?

Michele

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Re: 10061
« Reply #1 on: May 02, 2010, 07:50:52 PM »
Your question is not real clear.  Are you asking if 10060 or 10061 can be billed using units?  By definition 10061 is "complicated or multiple".

Michele
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blhoffman

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Re: 10061
« Reply #2 on: May 03, 2010, 08:26:30 AM »
Hi bliss,

I found this information while researching your question.  ;D

The definitions are "simple or single" and "complex or multiple." Two abscesses would indicate "multiple."

Bill 10060 if there is one abscess that is simple.
Bill 10061 if there is more than one abscess, or there is one abscess that is complicated.

I believe that in either case, you would use one unit. The work value for the 10061 reflects the more complicated work for one abscess, and/or the more involved work for multiple abscesses.

oneround

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Re: 10061
« Reply #3 on: May 03, 2010, 11:42:39 AM »
Correct, The MD makes a small incision through the skin overlying an abcess for I&D, the lesion may be curretted and irrigated.  10061 would be coded for complicated or multiple cysts, complicated cysts may require later surgical clousure.  10060 is for I&D of a simple or single abcess. Because 10061 states multiple, you could treat up tp 10 lesions but bill it only as 10061 X 1 In either case 1 unit would be applicable.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

bliss

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Re: 10061
« Reply #4 on: May 05, 2010, 08:01:36 PM »
Thank you all for replying.  Scenario:  Just to clarify more, we have patients that come on a weekly,
or Bi-weekly basis.  They all have one or more of these: Acne, Acne Vulgaris, cystic acne, folliculitis. 
Pustules abcesses, or cystic, They all require I&D of some sort.  Not sure if classified as complicated.  A lancet used only, There are multiple lesions.  What would we bill?  I was told at one point that the 10061 can be billed with several units, X1, X2 .....all the way up to X18 if there are 18 lesions, or depending on how many lesions are lancet, so that  is what we have been doing for a long while.  I am very concerned, because our company had been billing 10040, 10061X how many units, or lesions,
& 99213, and I am now wondering if that was wrong.  We have been getting paid from insurance company with these billings.  Please give me some insight.

oneround

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Re: 10061
« Reply #5 on: May 06, 2010, 01:04:19 PM »
Check with your in-house there would be circumstances when you would, if pt cam in weekly and you billed monthly then the procedure would be billed as 1006x or 10061X.  Here is anohter example, look at 11200 and 11201.  If 3 tags were removed  It would be 11200 if 45 were removed it would be 11200 and 11201,11201,11201 or  11200 and11201 x3 form a coding aspect.  Also keep in mind that it depends on how your carrier wants you to bill the service.  Now back to 10061, Complicated or Multiple I wanna say runs in the the 100.00 payout range, so you tack a x4 on the baby you getting paid 400.00 but then again it could be that your carrier wants to know how many lesions are being abcessed.

ClaimCheck Clinical Edit Clarification
Inquiry:
Why is procedure 10061 disallowed when submitted more than the maximum
times allowed?
Code Description
10061
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE,
SUPPURATIVE HIDRADENITIS, CUTANEOUS OR
SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR
PARONYCHIA); COMPLICATED OR MULTIPLE
Response:
Procedure 10061 is used to report incision and drainage of multiple or complicated
skin abscesses such as carbuncle, suppurative hidradentis, cutaneous or
subcutaneous abscess, cyst, furuncle, or paronychia. Typically, the operative site is
opened to drain, clean, and remove any infected or necrotic tissues.
A duplicate edit occurs when a procedure code description contains terminology that
does not warrant multiple submissions of that procedure for a single date of service.
This includes the following terms: Bilateral, Unilateral/bilateral, Single/multiple. A
Duplicate edit or review also occurs when a procedure is submitted multiple times,
exceeding the maximum allowance that would be clinically appropriate.
Per it's CPT descriptor, code 10061 represents the incision and drainage of
"complicated or multiple" abscesses. As multiple abscesses are assumed to occur at
separate sites on the skin or subcutaneous tissue, 10061 is appropriately reported
one time to represent the drainage of more than a single abscess.
Therefore, procedure 10061 is disallowed when submitted more than the maximum
times allowed.
Sources:
This edit is consistent with CPT coding guidelines.
Disclaimer:
Not for use or disclosure outside McKesson Information Solutions except under
written agreement.


Also;

ClaimCheck Clinical Edit Clarification
Inquiry:
Why is procedure 10060 disallowed when submitted with procedure 10061?
Code Description
10060
INCISION AND DRAINAGE OF ABSCESS (EG,CARBUNCLE,
SUPPURATIVE HIDRADENITIS, CUTANEOUS OR
SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR
PARONYCHIA); SIMPLE OR SINGLE
10061
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE,
SUPPURATIVE HIDRADENITIS, CUTANEOUS OR
SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR
PARONYCHIA); COMPLICATED OR MULTIPLE
Response:
Procedure 10061 is used to report incision and drainage of multiple or complicated
skin abscesses such as carbuncle, suppurative hidradentis, cutaneous or
subcutaneous abscess, cyst, furuncle, or paronychia. Typically, the operative site is
opened to drain, clean, and remove any infected or necrotic tissues.
Procedure 10060 is used to report the incision and drainage of a simple or single
abscess such as carbuncle, suppurative hidradenitis, cutaneous or subcutaneous
abscess, cyst, furuncle, or paronychia. The description of this procedure is not
specific to the site of the abscess.
CPT states that procedure 10060 represents single abscess drainage, while
procedure 10061 represents complicated or multiple abscesses. Thus, although
multiple abscesses would be located in separate anatomic locations, the procedure
for incision and drainage of more than one abscess, regardless of location, is
reported with 10061.
When similar or identical procedures are performed, but are qualified by an increased
level of complexity, only the definitive, or most comprehensive, service performed
should be reported. "Most Extensive Procedure" rationale as given in CMS' National
Correct Coding Policy Manual for Part B Medicare Carriers, p. IA-17 states "the
simple procedure is included in the complex procedure..." The reporting of both
represents overlap of service.
Therefore, procedure 10060 is not recommended for separate reimbursement when
submitted with procedure 10061.
Sources:
This edit is consistent with CMS coding guidelines.
This edit is consistent with the Correct Coding Initiative (CCI)
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

bliss

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Re: 10061
« Reply #6 on: May 12, 2010, 04:46:43 PM »
Thanks again!
How about debridment code, or chemical exfoliation code.  Would like to bill for those also, not sure exactly if they can be billed with
99213,10061, & 10040.  Those are the codes that we use on a daily basis. 

oneround

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Re: 10061
« Reply #7 on: May 13, 2010, 11:03:00 AM »
Billing debridments with I&D depends on body part and the depth because some of the incisions ar included in the debridments for example  27301 Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region - this code includes the incision and debriding of any necrotic tissue, per AAOS CodeX it states included in code 27301: "11. other incision and drainage (eg, 10060, 10061, 10140, 10160, 10180, 20000, 20005);  12. debridement"

There are dermabrasion codes in the 15780 series and also chemical exfoliation 17360. But if you are not meeting these descriptions it could just be part of the E/M service. If the provider feels that it was more than an E/M then you could look at the unlisted skin code.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

bliss

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Re: 10061
« Reply #8 on: May 17, 2010, 08:19:36 PM »
 :D  Wow thanks again, you have really helped with all these coding frustrations.  I may need some other info.  But for now I think I have received great info., and may be at peace.

Thanks,
again