6 Responses to “10060 Won’t Wash for Some I&Ds”

1. 

   Ken
   

   15. Jan, 2010

   How does this abcess automatically turn into a pilondial abscess? There is nothing in the documentation provided that would lead me to conclude this – is something missing from the encounter information? Because without a diagnosis of pilondial cyst or wording to that effect I’d have to say that this was a abscess of the trunk 682.2. Are all abscesses in the saccrococcygeal region automatically pilondial? I’m really having trouble accepting this!
2. 

   Jennifer
   

   17. Jan, 2010

   Without a diagnosis of pilondial cyst, I would not automatically code it as such. I would only code it to an I&D of pilondial cyst abscess if the physician diagnosed a pilondial cyst.
3. 

   Anne
   

   18. Jan, 2010

   I agree with Ken. I wouldn’t code this definitively as a pilondial cyst without specific documentation.
4. 

   Chris Boucher
   

   18. Jan, 2010

   Hi

   Thanks for writing about this touchy issue. I have conferred with both of my clinical editors, and we all agree that the most likely diagnosis is a pilonidal cyst; we also agree, however, that it might’ve been worded better.

   REASONING: We based our answer on 2 points:
   1. the coder had already been rejected for 10060, and the symptoms are very similar to pilonidal cysts. “When the physician performs I&Ds near the lower back or bottom of the coccyx, check to be sure he isn’t draining a pilonidal cyst, or you could miscode the encounter,” the answer states. We felt the next logical step with this type of injury, after being denied for 10060, would be to check if 10080 works.

   2. The reader states that the patient’s mass was painful, red, and slightly warm to the touch and she has a fever. According to the Mayo Clinic, pilonidal cyst symptoms include
   ■Pain
   ■Localized swelling
   ■Reddening of the skin
   ■Drainage of pus or blood from an opening in the skin (pilonidal sinus)
   ■Foul smell from draining pus
   ■Hair protruding from a pilonidal sinus
   ■Fever (uncommon).

   For those reasons, we recommended 10080 for this patient. We are aware that 10080 is rare, however, and try to stress that in the question.

   Again, I apologize for any confusion.

   Regards,
   Chris Boucher, CPC
   Editor in Chief
5. 

   Melanie Bivins
   

   19. Jan, 2010

   I don’t agree with 10080. Aren’t we trained not to assume? My interpretation of our coding guidelines differs from the above recommendation. Without a clear diagnosis of pilonidal cyst from the physician I would not code 10080.

   A physician query might be in order but with the information provided above I would not “diagnose” the patient myself to avoid a denial.
6. 

   Ken
   

   20. Jan, 2010

   There continues to be a problem with this then. You are choosing a code based on the chances of reimbursement – this is obviously against ethical coding standards. As for the pain/fever/reddening of skin/etc. – these are not symptoms exclusive to a pilondial cyst/abscess. All abscesses have swelling, pain and reddining of the skin. I think that this case would have been better appealed.