Health Information Management

Q&A: Coding for an ED patient with paronchyia

JustCoding News: Outpatient, April 7, 2010

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QUESTION: A physician diagnosed a patient in the ED with paronychia. The physician made an incision on the nail bed using a blade. The physician didn’t document whether there was pus. Does this mean I should only report ICD-9 procedure code 86.09 (Other incision of skin and subcutaneous tissue) because I can’t assume the physician performed an incision and drainage (I&D) or should I also code for I&D?

Also, is there any CPT code for the incision of nail bed or skin? I tried to crosswalk code 86.09 to get the CPT code, but I couldn't find one.

ANSWER: Paronychia is an infection around a nail. However, the term “infection” does not automatically include the presence of pus. You are correct that you cannot assume, so code 86.09 for an incision alone would be correct. However, it would be best for you to query the physician and have him or her document whether this was an I&D or if debridement was performed. If so, one of these codes it might be more accurate to report:

  • 86.04 (Other incision with drainage of skin and subcutaneous tissue)
  • 86.22 (Excisional debridement of wound, infection, or burn)

The same questions would apply when choosing a CPT code, such as code 10060 (Incision and drainage of abscess; simple or single). This code description specifically includes treatment of paronychia. Proper treatment for paronychia includes cutting and draining the infected area, according to the National Institutes of Health. Therefore, querying the physician to determine whether the drainage occurred may solve your problem very easily. If the physician confirms that he or she did not perform drainage, you should append modifier -52 (Reduced services) to code 10060. Then, attach an explanation with the claim to report that the reduced service was that the physician did not perform drainage.

The ED is typically considered an outpatient facility, and therefore you should usually assign CPT codes to report services. However, there are exceptions to every rule, so you should check with your third-party payer.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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