Incision and drainage of abscess; simple or single
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. I&D procedure billed without documenting abscess or hematoma presence
Very Common10060 (incision and drainage of abscess/cyst/hematoma, simple) requires documentation of: (1) abscess/hematoma confirmed, (2) incision performed, (3) drainage occurred, (4) wound care provided. Denied when documentation vague ('possible abscess') or when simple aspiration performed (different code 10160).
Common Causes
- • Documentation states 'lesion drained' - not clear if abscess vs cyst vs simple fluid collection
- • Needle aspiration only performed - that's 10160, not 10060 (I&D requires incision)
- • Small pustule opened - may not qualify as I&D if no true abscess cavity
Resolution Strategy
Document complete I&D procedure: 'Abscess right forearm, 3cm diameter, fluctuant, erythematous. Area prepped and local anesthetic infiltrated. Incision made with #15 blade, purulent material expressed and cultured. Wound irrigated, loosely packed with iodoform gauze. Patient to return in 48 hours for packing change.' Must show: abscess identified, incision performed (not just needle), drainage achieved, wound packed/managed. If only needle aspiration, rebill 10160. Cannot appeal without documented I&D components.
2. Billed same day as E&M without modifier -25 or separate medical necessity
Common10060 has 10-day global period - E&M same day typically bundled unless significant, separately identifiable E&M beyond I&D decision. If patient presents for I&D and that's only service, E&M not separately billable. If separate medical problem addressed, modifier -25 required on E&M.
Common Causes
- • E&M billed for I&D evaluation only - not separate service (decision for procedure bundled)
- • Modifier -25 not on E&M - codes bundle without modifier
- • Same-day E&M for wound check after I&D - bundled in global period
Resolution Strategy
If E&M separately medically necessary (e.g., patient also has unrelated problem addressed), document clearly: 'Chief complaint 1: Abscess right forearm (I&D performed, see below). Chief complaint 2: New onset headaches x 5 days, evaluated separately (neurological exam, reviewed imaging).' Add modifier -25 to E&M. If E&M only for I&D decision, do not bill E&M - 10060 includes evaluation. Cannot appeal bundling without documented separate medical necessity.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For simple incision and drainage of single abscess
Common Scenarios
Documentation Requirements
- Location and size of abscess
- Method of drainage
- Amount of purulent material
- Wound care instructions
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes incision and drainage
- Includes local anesthesia
- Wound packing bundled when performed same session
- Multiple abscesses coded separately
- Complex I&D requires separate code
Exclusions
- 10061 (complicated or multiple abscess drainage)
- 10080 (incision and drainage of pilonidal cyst)
- 10140 (incision and drainage of hematoma)
Coding Notes
Clinical scenarios
- Location and size of abscess
- Method of drainage
- Amount of purulent material
- Location and size of abscess
- Method of drainage
- Amount of purulent material
- Location and size of abscess
- Method of drainage
- Amount of purulent material
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Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 10060 is the billing code for "Incision and drainage of abscess; simple or single". For simple incision and drainage of single abscess
Medicare pays approximately $124.21 for CPT 10060 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 10060 has a total RVU of 4.70, broken down as: Work RVU 2.00, Practice Expense RVU 2.50, and Malpractice RVU 0.20. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 10060 is "I&D procedure billed without documenting abscess or hematoma presence". 10060 (incision and drainage of abscess/cyst/hematoma, simple) requires documentation of: (1) abscess/hematoma confirmed, (2) incision performed, (3) drainage occurred, (4) wound care provided. Denied when documentation vague ('possible abscess') or when simple aspiration performed (different code 10160). Common causes include: Documentation states 'lesion drained' - not clear if abscess vs cyst vs simple fluid collection; Needle aspiration only performed - that's 10160, not 10060 (I&D requires incision). Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 10060 include: Location and size of abscess; Method of drainage; Amount of purulent material; Wound care instructions. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 10060: Includes incision and drainage. Includes local anesthesia Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 10060 include: 51 (Multiple procedures performed same session), 59 (Distinct procedural service if performed separately), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 10060 is 10-20 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.