SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures

A56766

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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General Information

Source Article ID
N/A
Article ID
A56766
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures
Article Type
Billing and Coding
Original Effective Date
08/01/2019
Revision Effective Date
01/01/2024
Revision Ending Date
11/01/2024
Retirement Date
N/A

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Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures.

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Paronychia, when sufficiently treated with avulsion of the nail only, should be billed with CPT code 11730 and not as an incision and drainage. Permanent correction of recurring ingrown toenail by nail resection or wedge excision of the nail lip should be billed with CPT code 11750 or 11765 and not as an incision and drainage.

Partial or complete avulsion of the toenail is a common treatment for paronychia in association with an ingrown nail. In fact, incision and drainage is not commonly performed for treatment of paronychia in the foot without avulsion of the toenail. This procedure usually effectively drains any associated infection. Therefore, the provider who performs this procedure to address a localized infection should bill the appropriate code 11730, and not one for an incision and drainage service.

Billing for incision and drainage procedures (CPT codes 10060, 10061, 10160) for treatment of paronychia of the foot when avulsion or resection of the toenail has been performed to treat the same condition, is not appropriate.

Pus-producing paronychia without ingrown toenail is relatively uncommon on the foot. Providers billing incision and drainage services for this condition must have medical record documentation available to Medicare on request. Then only CPT codes 10060, 10061, 10160 should be used and not combined with CPT codes 11750 or 11765.

For Podiatry (Specialty 48):

  • Claims for CPT codes 10060 or 10061 with diagnosis of furuncle/carbuncle (ICD-10-CM code L02.621, L02.622, L02.631, L02.632), suppurative hidradenitis (ICD-10-CM code L73.2) will be subject to review, as these diagnoses are not commonly found in the foot.
  • CPT codes 10060, 10061 or 10160 are payable for ICD-10-CM codes L02.611, L02.612, L98.8 only.
  • CPT code 10140 is payable only for ICD-10-CM codes L76.01, L76.02, L76.21, L76.22, S80.01XA, S80.01XD, S80.01XS, S80.02XA, S80.02XD, S80.02XS, S80.11XA*, S80.11XD*, S80.11XS*, S80.12XA*, S80.12XD*, S80.12XS*, S87.01XA, S87.01XD, S87.01XS, S87.02XA, S87.02XD, S87.02XS, S87.81XA*, S87.81XD*, S87.81XS*, S87.82XA*, S87.82XD*, S87.82XS*, S90.01XA, S90.01XD, S90.01XS, S90.02XA, S90.02XD, S90.02XS, S90.111A, S90.111D, S90.111S, S90.112A, S90.112D, S90.112S, S90.121A, S90.121D, S90.121S, S90.122A, S90.122D, S90.122S, S90.211A, S90.211D, S90.211S, S90.212A, S90.212D, S90.212S, S90.221A, S90.221D, S90.221S, S90.222A, S90.222D, S90.222S, S90.31XA, S90.31XD, S90.31XS, S90.32XA, S90.32XD, S90.32XS, S97.01XA, S97.01XD, S97.01XS, S97.02XA, S97.02XD, S97.02XS, S97.111A, S97.111D, S97.111S, S97.112A, S97.112D, S97.112S, S97.121A, S97.121D, S97.121S, S97.122A, S97.122D, S97.122S, S97.81XA, S97.81XD, S97.81XS, S97.82XA, S97.82XD, S97.82XS.

*As allowed by State law.

Anesthesia administered by or “incident to” the physician performing the incision and drainage service is included in the reimbursement for incision and drainage services and is not separately payable.

Documentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for services included within
the LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

The patient's medical record must document the signs/symptoms exhibited by the patient that required the incision and drainage procedure. This information must be available in the patient's record, if requested for review purposes. Additional information such as photographs, operative reports, or progress notes may be required from any provider who demonstrates a pattern of billing repeated incision and drainage services of the same anatomical area.

The pre-operative size, location and appearance of any abscess, hematoma or other lesion claimed to have undergone an incision and drainage service must be clearly documented in the medical record.

The operative note must include a description of the procedure, e.g. equipment used, and the approximate quantity (e.g., 1 cc, 5 ml) and quality (e.g., serous, sero-sanguinous, bloody, exudative, frank pus, malodorous) of the material drained from the collection.

Since the majority of hematomas, seromas and cysts do not require incision and drainage or aspiration, and since this procedure can actually increase the risk of infection, providers reporting these services must document the size, location and quantity of blood, material or serosanguinous fluid drained, as well as the medical necessity of the procedure, (e.g. severe pain or infection and failure to resolve with conservative measures).

Pus-producing paronychia without ingrown toenail is relatively uncommon on the foot. Providers billing incision and drainage services for this condition must have medical record documentation available to Medicare on request.

The Contractor retains the right to require of select providers photographic documentation of lesions prior to and/or after treatment if there are indications of abuse of any of the codes in this LCD.

Providers will be notified of this requirement individually and prior to such a requirement being instituted.

If a patient requires incision and drainage services repeatedly (more than once) for treatment of abscess in the same anatomic location, the medical record must clearly reflect the reason(s) for persistent or recurrent infection and what measures are being taken to avoid infections.

Utilization Guidelines:

A single drainage procedure for most abscesses, hematomas or other collections is often curative. It would be unusual for any individual lesion or collection to require more than two such services. Recurrent fluid or abscess collections or repeated need for incision and drainage services may indicate the need for additional medical or surgical measures to provide definitive treatment.

Multiple abscesses or fluid collections in the same patient requiring drainage, more than two times per year in the same location is uncommon. Services exceeding this parameter will be considered not medically necessary. Any claims which include a diagnosis of hidradenitis (ICD-10-CM code L73.2) will be excluded from this parameter. However, the documentation must be clear as to the reason more definitive therapy is not appropriate.


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Coding Information

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Group 1

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(565 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attached determination.

Group 1 Codes
Code Description
J34.0 Abscess, furuncle and carbuncle of nose
K12.2 Cellulitis and abscess of mouth
K13.0 Diseases of lips
K61.31 Horseshoe abscess
K61.39 Other ischiorectal abscess
K61.5 Supralevator abscess
K68.11 Postprocedural retroperitoneal abscess
L02.01 Cutaneous abscess of face
L02.02 Furuncle of face
L02.03 Carbuncle of face
L02.11 Cutaneous abscess of neck
L02.12 Furuncle of neck
L02.13 Carbuncle of neck
L02.211 Cutaneous abscess of abdominal wall
L02.212 Cutaneous abscess of back [any part, except buttock]
L02.213 Cutaneous abscess of chest wall
L02.214 Cutaneous abscess of groin
L02.215 Cutaneous abscess of perineum
L02.216 Cutaneous abscess of umbilicus
L02.221 Furuncle of abdominal wall
L02.222 Furuncle of back [any part, except buttock]
L02.223 Furuncle of chest wall
L02.224 Furuncle of groin
L02.225 Furuncle of perineum
L02.226 Furuncle of umbilicus
L02.231 Carbuncle of abdominal wall
L02.232 Carbuncle of back [any part, except buttock]
L02.233 Carbuncle of chest wall
L02.234 Carbuncle of groin
L02.235 Carbuncle of perineum
L02.236 Carbuncle of umbilicus
L02.31 Cutaneous abscess of buttock
L02.32 Furuncle of buttock
L02.33 Carbuncle of buttock
L02.411 Cutaneous abscess of right axilla
L02.412 Cutaneous abscess of left axilla
L02.413 Cutaneous abscess of right upper limb
L02.414 Cutaneous abscess of left upper limb
L02.415 Cutaneous abscess of right lower limb
L02.416 Cutaneous abscess of left lower limb
L02.421 Furuncle of right axilla
L02.422 Furuncle of left axilla
L02.423 Furuncle of right upper limb
L02.424 Furuncle of left upper limb
L02.425 Furuncle of right lower limb
L02.426 Furuncle of left lower limb
L02.431 Carbuncle of right axilla
L02.432 Carbuncle of left axilla
L02.433 Carbuncle of right upper limb
L02.434 Carbuncle of left upper limb
L02.435 Carbuncle of right lower limb
L02.436 Carbuncle of left lower limb
L02.511 Cutaneous abscess of right hand
L02.512 Cutaneous abscess of left hand
L02.521 Furuncle right hand
L02.522 Furuncle left hand
L02.531 Carbuncle of right hand
L02.532 Carbuncle of left hand
L02.611 Cutaneous abscess of right foot
L02.612 Cutaneous abscess of left foot
L02.621 Furuncle of right foot
L02.622 Furuncle of left foot
L02.631 Carbuncle of right foot
L02.632 Carbuncle of left foot
L02.811 Cutaneous abscess of head [any part, except face]
L02.818 Cutaneous abscess of other sites
L02.821 Furuncle of head [any part, except face]
L02.828 Furuncle of other sites
L02.831 Carbuncle of head [any part, except face]
L02.838 Carbuncle of other sites
L03.011 Cellulitis of right finger
L03.012 Cellulitis of left finger
L03.021 Acute lymphangitis of right finger
L03.022 Acute lymphangitis of left finger
L03.031 Cellulitis of right toe
L03.032 Cellulitis of left toe
L03.041 Acute lymphangitis of right toe
L03.042 Acute lymphangitis of left toe
L03.111 Cellulitis of right axilla
L03.112 Cellulitis of left axilla
L03.113 Cellulitis of right upper limb
L03.114 Cellulitis of left upper limb
L03.115 Cellulitis of right lower limb
L03.116 Cellulitis of left lower limb
L03.121 Acute lymphangitis of right axilla
L03.122 Acute lymphangitis of left axilla
L03.123 Acute lymphangitis of right upper limb
L03.124 Acute lymphangitis of left upper limb
L03.125 Acute lymphangitis of right lower limb
L03.126 Acute lymphangitis of left lower limb
L03.211 Cellulitis of face
L03.212 Acute lymphangitis of face
L03.213 Periorbital cellulitis
L03.221 Cellulitis of neck
L03.222 Acute lymphangitis of neck
L03.311 Cellulitis of abdominal wall
L03.312 Cellulitis of back [any part except buttock]
L03.313 Cellulitis of chest wall
L03.314 Cellulitis of groin
L03.315 Cellulitis of perineum
L03.316 Cellulitis of umbilicus
L03.317 Cellulitis of buttock
L03.321 Acute lymphangitis of abdominal wall
L03.322 Acute lymphangitis of back [any part except buttock]
L03.323 Acute lymphangitis of chest wall
L03.324 Acute lymphangitis of groin
L03.325 Acute lymphangitis of perineum
L03.326 Acute lymphangitis of umbilicus
L03.327 Acute lymphangitis of buttock
L03.811 Cellulitis of head [any part, except face]
L03.818 Cellulitis of other sites
L03.891 Acute lymphangitis of head [any part, except face]
L03.898 Acute lymphangitis of other sites
L05.01 Pilonidal cyst with abscess
L05.02 Pilonidal sinus with abscess
L05.91 Pilonidal cyst without abscess
L05.92 Pilonidal sinus without abscess
L44.8 Other specified papulosquamous disorders
L45 Papulosquamous disorders in diseases classified elsewhere
L72.0 Epidermal cyst
L72.2 Steatocystoma multiplex
L72.3 Sebaceous cyst
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L73.2 Hidradenitis suppurativa
L76.01 Intraoperative hemorrhage and hematoma of skin and subcutaneous tissue complicating a dermatologic procedure
L76.02 Intraoperative hemorrhage and hematoma of skin and subcutaneous tissue complicating other procedure
L76.21 Postprocedural hemorrhage of skin and subcutaneous tissue following a dermatologic procedure
L76.22 Postprocedural hemorrhage of skin and subcutaneous tissue following other procedure
L76.31 Postprocedural hematoma of skin and subcutaneous tissue following a dermatologic procedure
L76.32 Postprocedural hematoma of skin and subcutaneous tissue following other procedure
L76.33 Postprocedural seroma of skin and subcutaneous tissue following a dermatologic procedure
L76.34 Postprocedural seroma of skin and subcutaneous tissue following other procedure
L94.2 Calcinosis cutis
L94.4 Gottron's papules
L98.3 Eosinophilic cellulitis [Wells]
L98.8 Other specified disorders of the skin and subcutaneous tissue
L99 Other disorders of skin and subcutaneous tissue in diseases classified elsewhere
M23.000 Cystic meniscus, unspecified lateral meniscus, right knee
M23.001 Cystic meniscus, unspecified lateral meniscus, left knee
M23.003 Cystic meniscus, unspecified medial meniscus, right knee
M23.004 Cystic meniscus, unspecified medial meniscus, left knee
M23.006 Cystic meniscus, unspecified meniscus, right knee
M23.007 Cystic meniscus, unspecified meniscus, left knee
M23.011 Cystic meniscus, anterior horn of medial meniscus, right knee
M23.012 Cystic meniscus, anterior horn of medial meniscus, left knee
M23.021 Cystic meniscus, posterior horn of medial meniscus, right knee
M23.022 Cystic meniscus, posterior horn of medial meniscus, left knee
M23.031 Cystic meniscus, other medial meniscus, right knee
M23.032 Cystic meniscus, other medial meniscus, left knee
M23.041 Cystic meniscus, anterior horn of lateral meniscus, right knee
M23.042 Cystic meniscus, anterior horn of lateral meniscus, left knee
M23.051 Cystic meniscus, posterior horn of lateral meniscus, right knee
M23.052 Cystic meniscus, posterior horn of lateral meniscus, left knee
M23.061 Cystic meniscus, other lateral meniscus, right knee
M23.062 Cystic meniscus, other lateral meniscus, left knee
M66.0 Rupture of popliteal cyst
M71.21 Synovial cyst of popliteal space [Baker], right knee
M71.22 Synovial cyst of popliteal space [Baker], left knee
N61.1 Abscess of the breast and nipple
O91.011 Infection of nipple associated with pregnancy, first trimester
O91.012 Infection of nipple associated with pregnancy, second trimester
O91.013 Infection of nipple associated with pregnancy, third trimester
O91.02 Infection of nipple associated with the puerperium
O91.03 Infection of nipple associated with lactation
O91.111 Abscess of breast associated with pregnancy, first trimester
O91.112 Abscess of breast associated with pregnancy, second trimester
O91.113 Abscess of breast associated with pregnancy, third trimester
O91.12 Abscess of breast associated with the puerperium
O91.13 Abscess of breast associated with lactation
S00.03XA Contusion of scalp, initial encounter
S00.03XD Contusion of scalp, subsequent encounter
S00.03XS Contusion of scalp, sequela
S00.33XA Contusion of nose, initial encounter
S00.33XD Contusion of nose, subsequent encounter
S00.33XS Contusion of nose, sequela
S00.431A Contusion of right ear, initial encounter
S00.431D Contusion of right ear, subsequent encounter
S00.431S Contusion of right ear, sequela
S00.432A Contusion of left ear, initial encounter
S00.432D Contusion of left ear, subsequent encounter
S00.432S Contusion of left ear, sequela
S00.531A Contusion of lip, initial encounter
S00.531D Contusion of lip, subsequent encounter
S00.531S Contusion of lip, sequela
S00.532A Contusion of oral cavity, initial encounter
S00.532D Contusion of oral cavity, subsequent encounter
S00.532S Contusion of oral cavity, sequela
S00.83XA Contusion of other part of head, initial encounter
S00.83XD Contusion of other part of head, subsequent encounter
S00.83XS Contusion of other part of head, sequela
S07.0XXA Crushing injury of face, initial encounter
S07.0XXD Crushing injury of face, subsequent encounter
S07.0XXS Crushing injury of face, sequela
S07.1XXA Crushing injury of skull, initial encounter
S07.1XXD Crushing injury of skull, subsequent encounter
S07.1XXS Crushing injury of skull, sequela
S07.8XXA Crushing injury of other parts of head, initial encounter
S07.8XXD Crushing injury of other parts of head, subsequent encounter
S07.8XXS Crushing injury of other parts of head, sequela
S10.0XXA Contusion of throat, initial encounter
S10.0XXD Contusion of throat, subsequent encounter
S10.0XXS Contusion of throat, sequela
S10.83XA Contusion of other specified part of neck, initial encounter
S10.83XD Contusion of other specified part of neck, subsequent encounter
S10.83XS Contusion of other specified part of neck, sequela
S17.0XXA Crushing injury of larynx and trachea, initial encounter
S17.0XXD Crushing injury of larynx and trachea, subsequent encounter
S17.0XXS Crushing injury of larynx and trachea, sequela
S17.8XXA Crushing injury of other specified parts of neck, initial encounter
S17.8XXD Crushing injury of other specified parts of neck, subsequent encounter
S17.8XXS Crushing injury of other specified parts of neck, sequela
S20.01XA Contusion of right breast, initial encounter
S20.01XD Contusion of right breast, subsequent encounter
S20.01XS Contusion of right breast, sequela
S20.02XA Contusion of left breast, initial encounter
S20.02XD Contusion of left breast, subsequent encounter
S20.02XS Contusion of left breast, sequela
S20.211A Contusion of right front wall of thorax, initial encounter
S20.211D Contusion of right front wall of thorax, subsequent encounter
S20.211S Contusion of right front wall of thorax, sequela
S20.212A Contusion of left front wall of thorax, initial encounter
S20.212D Contusion of left front wall of thorax, subsequent encounter
S20.212S Contusion of left front wall of thorax, sequela
S20.221A Contusion of right back wall of thorax, initial encounter
S20.221D Contusion of right back wall of thorax, subsequent encounter
S20.221S Contusion of right back wall of thorax, sequela
S20.222A Contusion of left back wall of thorax, initial encounter
S20.222D Contusion of left back wall of thorax, subsequent encounter
S20.222S Contusion of left back wall of thorax, sequela
S28.0XXA Crushed chest, initial encounter
S28.0XXD Crushed chest, subsequent encounter
S28.0XXS Crushed chest, sequela
S30.0XXA Contusion of lower back and pelvis, initial encounter
S30.0XXD Contusion of lower back and pelvis, subsequent encounter
S30.0XXS Contusion of lower back and pelvis, sequela
S30.1XXA Contusion of abdominal wall, initial encounter
S30.1XXD Contusion of abdominal wall, subsequent encounter
S30.1XXS Contusion of abdominal wall, sequela
S30.21XA Contusion of penis, initial encounter
S30.21XD Contusion of penis, subsequent encounter
S30.21XS Contusion of penis, sequela
S30.22XA Contusion of scrotum and testes, initial encounter
S30.22XD Contusion of scrotum and testes, subsequent encounter
S30.22XS Contusion of scrotum and testes, sequela
S30.23XA Contusion of vagina and vulva, initial encounter
S30.23XD Contusion of vagina and vulva, subsequent encounter
S30.23XS Contusion of vagina and vulva, sequela
S30.3XXA Contusion of anus, initial encounter
S30.3XXD Contusion of anus, subsequent encounter
S30.3XXS Contusion of anus, sequela
S38.01XA Crushing injury of penis, initial encounter
S38.01XD Crushing injury of penis, subsequent encounter
S38.01XS Crushing injury of penis, sequela
S38.02XA Crushing injury of scrotum and testis, initial encounter
S38.02XD Crushing injury of scrotum and testis, subsequent encounter
S38.02XS Crushing injury of scrotum and testis, sequela
S38.03XA Crushing injury of vulva, initial encounter
S38.03XD Crushing injury of vulva, subsequent encounter
S38.03XS Crushing injury of vulva, sequela
S38.1XXA Crushing injury of abdomen, lower back, and pelvis, initial encounter
S38.1XXD Crushing injury of abdomen, lower back, and pelvis, subsequent encounter
S38.1XXS Crushing injury of abdomen, lower back, and pelvis, sequela
S40.011A Contusion of right shoulder, initial encounter
S40.011D Contusion of right shoulder, subsequent encounter
S40.011S Contusion of right shoulder, sequela
S40.012A Contusion of left shoulder, initial encounter
S40.012D Contusion of left shoulder, subsequent encounter
S40.012S Contusion of left shoulder, sequela
S40.021A Contusion of right upper arm, initial encounter
S40.021D Contusion of right upper arm, subsequent encounter
S40.021S Contusion of right upper arm, sequela
S40.022A Contusion of left upper arm, initial encounter
S40.022D Contusion of left upper arm, subsequent encounter
S40.022S Contusion of left upper arm, sequela
S47.1XXA Crushing injury of right shoulder and upper arm, initial encounter
S47.1XXD Crushing injury of right shoulder and upper arm, subsequent encounter
S47.1XXS Crushing injury of right shoulder and upper arm, sequela
S47.2XXA Crushing injury of left shoulder and upper arm, initial encounter
S47.2XXD Crushing injury of left shoulder and upper arm, subsequent encounter
S47.2XXS Crushing injury of left shoulder and upper arm, sequela
S50.01XA Contusion of right elbow, initial encounter
S50.01XD Contusion of right elbow, subsequent encounter
S50.01XS Contusion of right elbow, sequela
S50.02XA Contusion of left elbow, initial encounter
S50.02XD Contusion of left elbow, subsequent encounter
S50.02XS Contusion of left elbow, sequela
S50.11XA Contusion of right forearm, initial encounter
S50.11XD Contusion of right forearm, subsequent encounter
S50.11XS Contusion of right forearm, sequela
S50.12XA Contusion of left forearm, initial encounter
S50.12XD Contusion of left forearm, subsequent encounter
S50.12XS Contusion of left forearm, sequela
S57.01XA Crushing injury of right elbow, initial encounter
S57.01XD Crushing injury of right elbow, subsequent encounter
S57.01XS Crushing injury of right elbow, sequela
S57.02XA Crushing injury of left elbow, initial encounter
S57.02XD Crushing injury of left elbow, subsequent encounter
S57.02XS Crushing injury of left elbow, sequela
S57.81XA Crushing injury of right forearm, initial encounter
S57.81XD Crushing injury of right forearm, subsequent encounter
S57.81XS Crushing injury of right forearm, sequela
S57.82XA Crushing injury of left forearm, initial encounter
S57.82XD Crushing injury of left forearm, subsequent encounter
S57.82XS Crushing injury of left forearm, sequela
S60.011A Contusion of right thumb without damage to nail, initial encounter
S60.011D Contusion of right thumb without damage to nail, subsequent encounter
S60.011S Contusion of right thumb without damage to nail, sequela
S60.012A Contusion of left thumb without damage to nail, initial encounter
S60.012D Contusion of left thumb without damage to nail, subsequent encounter
S60.012S Contusion of left thumb without damage to nail, sequela
S60.021A Contusion of right index finger without damage to nail, initial encounter
S60.021D Contusion of right index finger without damage to nail, subsequent encounter
S60.021S Contusion of right index finger without damage to nail, sequela
S60.022A Contusion of left index finger without damage to nail, initial encounter
S60.022D Contusion of left index finger without damage to nail, subsequent encounter
S60.022S Contusion of left index finger without damage to nail, sequela
S60.031A Contusion of right middle finger without damage to nail, initial encounter
S60.031D Contusion of right middle finger without damage to nail, subsequent encounter
S60.031S Contusion of right middle finger without damage to nail, sequela
S60.032A Contusion of left middle finger without damage to nail, initial encounter
S60.032D Contusion of left middle finger without damage to nail, subsequent encounter
S60.032S Contusion of left middle finger without damage to nail, sequela
S60.041A Contusion of right ring finger without damage to nail, initial encounter
S60.041D Contusion of right ring finger without damage to nail, subsequent encounter
S60.041S Contusion of right ring finger without damage to nail, sequela
S60.042A Contusion of left ring finger without damage to nail, initial encounter
S60.042D Contusion of left ring finger without damage to nail, subsequent encounter
S60.042S Contusion of left ring finger without damage to nail, sequela
S60.051A Contusion of right little finger without damage to nail, initial encounter
S60.051D Contusion of right little finger without damage to nail, subsequent encounter
S60.051S Contusion of right little finger without damage to nail, sequela
S60.052A Contusion of left little finger without damage to nail, initial encounter
S60.052D Contusion of left little finger without damage to nail, subsequent encounter
S60.052S Contusion of left little finger without damage to nail, sequela
S60.111A Contusion of right thumb with damage to nail, initial encounter
S60.111D Contusion of right thumb with damage to nail, subsequent encounter
S60.111S Contusion of right thumb with damage to nail, sequela
S60.112A Contusion of left thumb with damage to nail, initial encounter
S60.112D Contusion of left thumb with damage to nail, subsequent encounter
S60.112S Contusion of left thumb with damage to nail, sequela
S60.121A Contusion of right index finger with damage to nail, initial encounter
S60.121D Contusion of right index finger with damage to nail, subsequent encounter
S60.121S Contusion of right index finger with damage to nail, sequela
S60.122A Contusion of left index finger with damage to nail, initial encounter
S60.122D Contusion of left index finger with damage to nail, subsequent encounter
S60.122S Contusion of left index finger with damage to nail, sequela
S60.131A Contusion of right middle finger with damage to nail, initial encounter
S60.131D Contusion of right middle finger with damage to nail, subsequent encounter
S60.131S Contusion of right middle finger with damage to nail, sequela
S60.132A Contusion of left middle finger with damage to nail, initial encounter
S60.132D Contusion of left middle finger with damage to nail, subsequent encounter
S60.132S Contusion of left middle finger with damage to nail, sequela
S60.141A Contusion of right ring finger with damage to nail, initial encounter
S60.141D Contusion of right ring finger with damage to nail, subsequent encounter
S60.141S Contusion of right ring finger with damage to nail, sequela
S60.142A Contusion of left ring finger with damage to nail, initial encounter
S60.142D Contusion of left ring finger with damage to nail, subsequent encounter
S60.142S Contusion of left ring finger with damage to nail, sequela
S60.151A Contusion of right little finger with damage to nail, initial encounter
S60.151D Contusion of right little finger with damage to nail, subsequent encounter
S60.151S Contusion of right little finger with damage to nail, sequela
S60.152A Contusion of left little finger with damage to nail, initial encounter
S60.152D Contusion of left little finger with damage to nail, subsequent encounter
S60.152S Contusion of left little finger with damage to nail, sequela
S60.211A Contusion of right wrist, initial encounter
S60.211D Contusion of right wrist, subsequent encounter
S60.211S Contusion of right wrist, sequela
S60.212A Contusion of left wrist, initial encounter
S60.212D Contusion of left wrist, subsequent encounter
S60.212S Contusion of left wrist, sequela
S60.221A Contusion of right hand, initial encounter
S60.221D Contusion of right hand, subsequent encounter
S60.221S Contusion of right hand, sequela
S60.222A Contusion of left hand, initial encounter
S60.222D Contusion of left hand, subsequent encounter
S60.222S Contusion of left hand, sequela
S67.01XA Crushing injury of right thumb, initial encounter
S67.01XD Crushing injury of right thumb, subsequent encounter
S67.01XS Crushing injury of right thumb, sequela
S67.02XA Crushing injury of left thumb, initial encounter
S67.02XD Crushing injury of left thumb, subsequent encounter
S67.02XS Crushing injury of left thumb, sequela
S67.190A Crushing injury of right index finger, initial encounter
S67.190D Crushing injury of right index finger, subsequent encounter
S67.190S Crushing injury of right index finger, sequela
S67.191A Crushing injury of left index finger, initial encounter
S67.191D Crushing injury of left index finger, subsequent encounter
S67.191S Crushing injury of left index finger, sequela
S67.192A Crushing injury of right middle finger, initial encounter
S67.192D Crushing injury of right middle finger, subsequent encounter
S67.192S Crushing injury of right middle finger, sequela
S67.193A Crushing injury of left middle finger, initial encounter
S67.193D Crushing injury of left middle finger, subsequent encounter
S67.193S Crushing injury of left middle finger, sequela
S67.194A Crushing injury of right ring finger, initial encounter
S67.194D Crushing injury of right ring finger, subsequent encounter
S67.194S Crushing injury of right ring finger, sequela
S67.195A Crushing injury of left ring finger, initial encounter
S67.195D Crushing injury of left ring finger, subsequent encounter
S67.195S Crushing injury of left ring finger, sequela
S67.196A Crushing injury of right little finger, initial encounter
S67.196D Crushing injury of right little finger, subsequent encounter
S67.196S Crushing injury of right little finger, sequela
S67.197A Crushing injury of left little finger, initial encounter
S67.197D Crushing injury of left little finger, subsequent encounter
S67.197S Crushing injury of left little finger, sequela
S67.198A Crushing injury of other finger, initial encounter
S67.198D Crushing injury of other finger, subsequent encounter
S67.198S Crushing injury of other finger, sequela
S67.21XA Crushing injury of right hand, initial encounter
S67.21XD Crushing injury of right hand, subsequent encounter
S67.21XS Crushing injury of right hand, sequela
S67.22XA Crushing injury of left hand, initial encounter
S67.22XD Crushing injury of left hand, subsequent encounter
S67.22XS Crushing injury of left hand, sequela
S67.31XA Crushing injury of right wrist, initial encounter
S67.31XD Crushing injury of right wrist, subsequent encounter
S67.31XS Crushing injury of right wrist, sequela
S67.32XA Crushing injury of left wrist, initial encounter
S67.32XD Crushing injury of left wrist, subsequent encounter
S67.32XS Crushing injury of left wrist, sequela
S67.41XA Crushing injury of right wrist and hand, initial encounter
S67.41XD Crushing injury of right wrist and hand, subsequent encounter
S67.41XS Crushing injury of right wrist and hand, sequela
S67.42XA Crushing injury of left wrist and hand, initial encounter
S67.42XD Crushing injury of left wrist and hand, subsequent encounter
S67.42XS Crushing injury of left wrist and hand, sequela
S70.01XA Contusion of right hip, initial encounter
S70.01XD Contusion of right hip, subsequent encounter
S70.01XS Contusion of right hip, sequela
S70.02XA Contusion of left hip, initial encounter
S70.02XD Contusion of left hip, subsequent encounter
S70.02XS Contusion of left hip, sequela
S70.11XA Contusion of right thigh, initial encounter
S70.11XD Contusion of right thigh, subsequent encounter
S70.11XS Contusion of right thigh, sequela
S70.12XA Contusion of left thigh, initial encounter
S70.12XD Contusion of left thigh, subsequent encounter
S70.12XS Contusion of left thigh, sequela
S77.01XA Crushing injury of right hip, initial encounter
S77.01XD Crushing injury of right hip, subsequent encounter
S77.01XS Crushing injury of right hip, sequela
S77.02XA Crushing injury of left hip, initial encounter
S77.02XD Crushing injury of left hip, subsequent encounter
S77.02XS Crushing injury of left hip, sequela
S77.11XA Crushing injury of right thigh, initial encounter
S77.11XD Crushing injury of right thigh, subsequent encounter
S77.11XS Crushing injury of right thigh, sequela
S77.12XA Crushing injury of left thigh, initial encounter
S77.12XD Crushing injury of left thigh, subsequent encounter
S77.12XS Crushing injury of left thigh, sequela
S77.21XA Crushing injury of right hip with thigh, initial encounter
S77.21XD Crushing injury of right hip with thigh, subsequent encounter
S77.21XS Crushing injury of right hip with thigh, sequela
S77.22XA Crushing injury of left hip with thigh, initial encounter
S77.22XD Crushing injury of left hip with thigh, subsequent encounter
S77.22XS Crushing injury of left hip with thigh, sequela
S80.01XA Contusion of right knee, initial encounter
S80.01XD Contusion of right knee, subsequent encounter
S80.01XS Contusion of right knee, sequela
S80.02XA Contusion of left knee, initial encounter
S80.02XD Contusion of left knee, subsequent encounter
S80.02XS Contusion of left knee, sequela
S80.11XA Contusion of right lower leg, initial encounter
S80.11XD Contusion of right lower leg, subsequent encounter
S80.11XS Contusion of right lower leg, sequela
S80.12XA Contusion of left lower leg, initial encounter
S80.12XD Contusion of left lower leg, subsequent encounter
S80.12XS Contusion of left lower leg, sequela
S87.01XA Crushing injury of right knee, initial encounter
S87.01XD Crushing injury of right knee, subsequent encounter
S87.01XS Crushing injury of right knee, sequela
S87.02XA Crushing injury of left knee, initial encounter
S87.02XD Crushing injury of left knee, subsequent encounter
S87.02XS Crushing injury of left knee, sequela
S87.81XA Crushing injury of right lower leg, initial encounter
S87.81XD Crushing injury of right lower leg, subsequent encounter
S87.81XS Crushing injury of right lower leg, sequela
S87.82XA Crushing injury of left lower leg, initial encounter
S87.82XD Crushing injury of left lower leg, subsequent encounter
S87.82XS Crushing injury of left lower leg, sequela
S90.01XA Contusion of right ankle, initial encounter
S90.01XD Contusion of right ankle, subsequent encounter
S90.01XS Contusion of right ankle, sequela
S90.02XA Contusion of left ankle, initial encounter
S90.02XD Contusion of left ankle, subsequent encounter
S90.02XS Contusion of left ankle, sequela
S90.111A Contusion of right great toe without damage to nail, initial encounter
S90.111D Contusion of right great toe without damage to nail, subsequent encounter
S90.111S Contusion of right great toe without damage to nail, sequela
S90.112A Contusion of left great toe without damage to nail, initial encounter
S90.112D Contusion of left great toe without damage to nail, subsequent encounter
S90.112S Contusion of left great toe without damage to nail, sequela
S90.121A Contusion of right lesser toe(s) without damage to nail, initial encounter
S90.121D Contusion of right lesser toe(s) without damage to nail, subsequent encounter
S90.121S Contusion of right lesser toe(s) without damage to nail, sequela
S90.122A Contusion of left lesser toe(s) without damage to nail, initial encounter
S90.122D Contusion of left lesser toe(s) without damage to nail, subsequent encounter
S90.122S Contusion of left lesser toe(s) without damage to nail, sequela
S90.211A Contusion of right great toe with damage to nail, initial encounter
S90.211D Contusion of right great toe with damage to nail, subsequent encounter
S90.211S Contusion of right great toe with damage to nail, sequela
S90.212A Contusion of left great toe with damage to nail, initial encounter
S90.212D Contusion of left great toe with damage to nail, subsequent encounter
S90.212S Contusion of left great toe with damage to nail, sequela
S90.221A Contusion of right lesser toe(s) with damage to nail, initial encounter
S90.221D Contusion of right lesser toe(s) with damage to nail, subsequent encounter
S90.221S Contusion of right lesser toe(s) with damage to nail, sequela
S90.222A Contusion of left lesser toe(s) with damage to nail, initial encounter
S90.222D Contusion of left lesser toe(s) with damage to nail, subsequent encounter
S90.222S Contusion of left lesser toe(s) with damage to nail, sequela
S90.31XA Contusion of right foot, initial encounter
S90.31XD Contusion of right foot, subsequent encounter
S90.31XS Contusion of right foot, sequela
S90.32XA Contusion of left foot, initial encounter
S90.32XD Contusion of left foot, subsequent encounter
S90.32XS Contusion of left foot, sequela
S97.01XA Crushing injury of right ankle, initial encounter
S97.01XD Crushing injury of right ankle, subsequent encounter
S97.01XS Crushing injury of right ankle, sequela
S97.02XA Crushing injury of left ankle, initial encounter
S97.02XD Crushing injury of left ankle, subsequent encounter
S97.02XS Crushing injury of left ankle, sequela
S97.111A Crushing injury of right great toe, initial encounter
S97.111D Crushing injury of right great toe, subsequent encounter
S97.111S Crushing injury of right great toe, sequela
S97.112A Crushing injury of left great toe, initial encounter
S97.112D Crushing injury of left great toe, subsequent encounter
S97.112S Crushing injury of left great toe, sequela
S97.121A Crushing injury of right lesser toe(s), initial encounter
S97.121D Crushing injury of right lesser toe(s), subsequent encounter
S97.121S Crushing injury of right lesser toe(s), sequela
S97.122A Crushing injury of left lesser toe(s), initial encounter
S97.122D Crushing injury of left lesser toe(s), subsequent encounter
S97.122S Crushing injury of left lesser toe(s), sequela
S97.81XA Crushing injury of right foot, initial encounter
S97.81XD Crushing injury of right foot, subsequent encounter
S97.81XS Crushing injury of right foot, sequela
S97.82XA Crushing injury of left foot, initial encounter
S97.82XD Crushing injury of left foot, subsequent encounter
S97.82XS Crushing injury of left foot, sequela
T81.31XA Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter
T81.31XD Disruption of external operation (surgical) wound, not elsewhere classified, subsequent encounter
T81.31XS Disruption of external operation (surgical) wound, not elsewhere classified, sequela
T81.41XA Infection following a procedure, superficial incisional surgical site, initial encounter
T81.41XD Infection following a procedure, superficial incisional surgical site, subsequent encounter
T81.41XS Infection following a procedure, superficial incisional surgical site, sequela
T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter
T81.42XD Infection following a procedure, deep incisional surgical site, subsequent encounter
T81.42XS Infection following a procedure, deep incisional surgical site, sequela
T81.43XA Infection following a procedure, organ and space surgical site, initial encounter
T81.43XD Infection following a procedure, organ and space surgical site, subsequent encounter
T81.43XS Infection following a procedure, organ and space surgical site, sequela
T81.44XA Sepsis following a procedure, initial encounter
T81.44XD Sepsis following a procedure, subsequent encounter
T81.44XS Sepsis following a procedure, sequela
T81.49XA Infection following a procedure, other surgical site, initial encounter
T81.49XD Infection following a procedure, other surgical site, subsequent encounter
T81.49XS Infection following a procedure, other surgical site, sequela
T82.898A Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T82.898D Other specified complication of vascular prosthetic devices, implants and grafts, subsequent encounter
T82.898S Other specified complication of vascular prosthetic devices, implants and grafts, sequela
T88.8XXA Other specified complications of surgical and medical care, not elsewhere classified, initial encounter
T88.8XXD Other specified complications of surgical and medical care, not elsewhere classified, subsequent encounter
T88.8XXS Other specified complications of surgical and medical care, not elsewhere classified, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R3

Due to the annual CPT/HCPCS code updates, either the short and/or long code description was changed for CPT codes 10060, 10061, 10080, 10081, 10140, 10160, and 10180. Please Note: Depending on which descriptor was used, there may not be any changes to the code display in this document.

04/01/2023 R2

This article has been updated to add the following ICD-10 codes: L05.91 and L05.92.

09/12/2019 R1

Bill types and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/12/2024 11/02/2024 - N/A Currently in Effect View
12/21/2023 01/01/2024 - 11/01/2024 Superseded You are here
03/10/2023 04/01/2023 - 12/31/2023 Superseded View
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