Incision and drainage of complex abscess, hematoma, or fluid collection

CPT 10180 is the billing code for "Incision and drainage of complex abscess, hematoma, or fluid collection". Complex incision and drainage requiring extensive exploration, debridement, or placement of drain

Medicare pays approximately $255.86 for CPT 10180 (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 10180 has a total RVU of 3.12, broken down as: Work RVU 1.50, Practice Expense RVU 1.50, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 10180 include: Complexity documented; Extent of drainage documented; Debridement performed if applicable; Drain placement if applicable. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 10180: Complex drainage procedure. May include extensive debridement Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 10180 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 10180 is Typically 30-60 minutes. Time-based codes require documentation of the actual time spent providing the service.