Incision and drainage of pilonidal cyst, simple

CPT 10080 is the billing code for "Incision and drainage of pilonidal cyst, simple". Simple incision and drainage of pilonidal cyst without extensive excision

Medicare pays approximately $238.39 for CPT 10080 (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 10080 has a total RVU of 2.55, broken down as: Work RVU 1.25, Practice Expense RVU 1.20, and Malpractice RVU 0.10. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 10080 include: Location documented (pilonidal area); Method of drainage documented; Extent of drainage documented; Patient response to treatment. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 10080: Simple drainage only. Does not include extensive excision Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 10080 include: 59 (Distinct procedural service when multiple procedures performed), 78 (Unplanned return to operating room). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 10080 is Typically 20-30 minutes. Time-based codes require documentation of the actual time spent providing the service.