Should You do Medical Billing for Excision or Incision?

Should You do Medical Billing for Excision or Incision?

The two medical billing terms excision and incision sound quite similar, but they are actually quite different in definition. There are certain situations in which it can be very confusing whether an incision & drainage code should be used, or and excision code. If you know the rules, the question of when to bill for an excision over an incision & drainage is a simple medical billing rule.

Let’s look at an example. Your surgeon has a patient that has a sebaceous cyst. He/she needs to check and see if that cyst is benign or malignant. The surgeon goes in with an incision and drains out 2-3 cc of fluid from the cyst. Then he/she removes as much of the glandular wall as possible. Some medical billing staff might wonder if they should bill for an incision and drainage, or an excision in this situation.

The answer is not cut and dry. No question in medical billing is every cut and dry. If the physician drains the cyst, but does not remove it, he/she would bill a 10060 or 10061 (incision and drainage of abscess). If the physician actually performs a full thickness removal of the cyst, than you could use 11442 (excision, other benign lesion including margins, face, ears, eyelids, nose, lips, mucous membrane; excised diameter) in medical billing.

As a medical billing staff member, it is important to be able to recognize what procedures were performed. You must be able to read the operative and pathology reports and patient records to deduct the code from that information given. Surgeons and physicians can be less than helpful when it comes to medical billing procedure. If you leave the surgery to them, they will leave the medical billing up to you.

View all Articles by: Melissa Clark, CCS-P