Summary & Overview
CPT 10060: Incision and Drainage of Simple Abscess
CPT code 10060 represents the incision and drainage of a simple or single abscess, a common surgical procedure performed in outpatient settings. This code is widely used by physicians across specialties, including surgery, family medicine, and emergency medicine, to treat localized infections and prevent their spread. The procedure is typically conducted in an office environment, making it accessible for patients with uncomplicated skin abscesses.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare provide coverage for this service, reflecting its clinical importance and frequency in medical practice. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and relevant coding details, including associated modifiers and related CPT codes. Readers will gain insight into the clinical context, coding requirements, and policy updates that impact reimbursement and compliance for this procedure.
Key topics include the use of modifiers 58 and 59, associated provider taxonomies, and common ICD-10 diagnoses linked to abscess and cellulitis. The article also highlights related CPT codes for more complex or multiple abscess procedures and office visits, providing a broader understanding of the coding landscape for incision and drainage services.
CPT Code Overview
CPT code 10060 is used to report the incision and drainage of an abscess, specifically when the procedure is considered simple or single. This service falls under the surgery category and is most commonly performed in an office setting (Place of Service 11). The procedure involves making an incision to drain pus or infected material from a localized collection, providing relief and preventing further complications. It is a routine intervention for patients presenting with uncomplicated skin abscesses.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with a painful, swollen area on the skin, commonly in the axilla or abdominal wall. On examination, the area is diagnosed as a cutaneous abscess, which may be accompanied by cellulitis. The provider determines that the abscess requires a simple incision and drainage procedure. After obtaining consent, the area is anesthetized, and a sterile incision is made to drain the pus. The wound is irrigated and dressed. The patient is monitored for improvement and may be scheduled for follow-up if needed. This procedure is typically performed in an office setting by a physician specializing in surgery, family medicine, or emergency medicine.
Coding Specifications
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Modifiers:
- Modifier
58: Used when a staged or related procedure or service is performed by the same physician during the postoperative period. For example, if a second incision and drainage is required due to persistent infection. - Modifier
59: Used to indicate a distinct procedural service, such as when multiple abscesses are treated in separate anatomical locations during the same encounter.
- Modifier
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Provider Taxonomies:
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