Incisions – Complicated

Coding Guidelines

CPT classifies some incisions as “complicated”. The following codes for “complicated” incisions will be recognized when they meet the following guidelines:

10061

Incision and drainage of abscess (e.g. carbuncle, suppurative hidradenitis, cutaneous or subcutaneous, abscess, cyst, furuncle, or paronychia); complicated or multiple.

For example, for an incision and drainage of an abscess to be classified as “complicated”, there must be extensive debridement, multiple incisions, or extensive dissection. Insertion of a Penrose latex drain or gauze strip packing to allow continued drainage does not in and of itself constitute complicated incision and drainage. Complicated cysts may require later surgical closure.

When 10061 is used to describe the incision and drainage of multiple cysts, the unit value in the days or units column (24G) of the CMS 1500 claim form should be “1”.

10081

Incision and drainage of pilonidal cyst; complicated.

For an incision and drainage of a pilonidal cyst to be classified as “complicated”, the procedure must include the excision of tissue, primary closure, and/or Z-plasty.

10121

Incision and removal of foreign body, subcutaneous tissues; complicated.

For an incision and removal of a foreign body from subcutaneous tissues to be classified as “complicated”, the procedure must include extensive dissection of underlying tissues and/or the adjunctive use of imaging guidance.

Documentation

Documentation supporting the medical necessity should be legible and maintained in the patient’s medical record and made available to HMSA upon request. Documentation must include pertinent information about any drains or packing used, delay of final closure, excision of tissue, dissection of underlying tissues, and type of closure, if any. If a layered closure is done, documentation should indicate the layers involved, number of sutures used in each layer, total length of the repair in centimeters, and any debridement or reconfiguration performed. HMSA reserves the right to perform retrospective reviews using the above criteria to validate if services rendered met payment determination criteria.

Revision History