CPT codes 10080 and 10081 refer to procedures involving the skin, or integumentary system.
CPT is a reference to the Current Procedural Terminology code book used to bill a patient's insurance company to obtain reimbursement for services rendered. The CPT code book is in sections and organized by body system. Sections are also in the CPT manual for medications, radiology procedures, and pathology and lab procedures. Codes 10080 and 10081 can be found in the surgery section. Although there is a slight difference in these two codes, the difference determines the amount of reimbursement.
Code 10080
Code 10080 is defined in the CPT manual as the simple incision and drainage of a pilonidal cyst. Incision and drainage procedures typically have a 10-day global period and cannot be approved for an assistant surgeon by the third-party payer, or the insurance company, as long as medical necessity has been shown.
Code 10081
A complicated Incision and drainage of a pilonidal cyst is coded with 10081. There are no American Medical Association guidelines for a coder to choose between simple or complicated. This is at the discretion of the treating physician and depends on the amount of work and the difficulty involved in the procedure.
Read the Notes
Notes are printed at the beginning of each section to add more information and sometimes site codes that may be excluded. These notes should be read carefully before choosing a code. Also read the chart carefully. If the cyst is excised instead, a code from 11400 to 11646 would be used.
Medical Necessity
Using the proper code from the ICD-9 diagnosis manual proves medical necessity. If a medical provider fails to prove medical necessity, the claim will be denied. Codes 685.0; pilonidal cyst with abscess, and 685.1; pilonidal cyst with no mention of abscess; are the proper codes for these CPT procedures. When billing these procedures, the physician must show documentation of the abscess in the medical record stating a description of the cyst and any tests or test results.
The Difference
The difference between CPT codes 10080 and 10081 is that the first is stated as simple and the latter as complicated. A procedure listed as complicated incision and drainage of a pilonidal cyst uses a local anesthesia and an oral antibiotic is mandatory for this type of complicated procedure to prevent infection.
Tags: pilonidal cyst, 10080 10081, drainage pilonidal, drainage pilonidal cyst, medical necessity