Definition of Simple versus Complicated

Definition of Simple versus Complicated

November 14, 2019

Question:
What is the definition of simple vs complicated for the I&D codes 10060 versus 10061?

Answer:
While CPT doesn’t define the difference between “simple” and “complicated”, it is the accepted practice that a simple I&D 10060 is just that. An incision (not just a puncture) is performed, and the abscess is left open to drain and heal. A complicated I&D 10061 would usually require one or more of the following: multiple incisions, probing to break up loculations, extensive packing, drain placements, and wound closure. If documentation isn’t clear on what exactly was performed, ask the provider for guidance as the reimbursement difference with these codes is fairly significant.

*This response is based on the best information available as of 11/14/19.

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