Summary & Overview
CPT 10060: Incision and Drainage of Simple Abscess
CPT code 10060 represents the incision and drainage of a simple or single abscess, a common surgical procedure performed in outpatient settings. This code is widely used by physicians across specialties, including surgery, family medicine, and emergency medicine, to treat localized infections and prevent their spread. The procedure is typically conducted in an office environment, making it accessible for patients with uncomplicated skin abscesses.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare provide coverage for this service, reflecting its clinical importance and frequency in medical practice. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and relevant coding details, including associated modifiers and related CPT codes. Readers will gain insight into the clinical context, coding requirements, and policy updates that impact reimbursement and compliance for this procedure.
Key topics include the use of modifiers 58 and 59, associated provider taxonomies, and common ICD-10 diagnoses linked to abscess and cellulitis. The article also highlights related CPT codes for more complex or multiple abscess procedures and office visits, providing a broader understanding of the coding landscape for incision and drainage services.
CPT Code Overview
CPT code 10060 is used to report the incision and drainage of an abscess, specifically when the procedure is considered simple or single. This service falls under the surgery category and is most commonly performed in an office setting (Place of Service 11). The procedure involves making an incision to drain pus or infected material from a localized collection, providing relief and preventing further complications. It is a routine intervention for patients presenting with uncomplicated skin abscesses.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with a painful, swollen area on the skin, commonly in the axilla or abdominal wall. On examination, the area is diagnosed as a cutaneous abscess, which may be accompanied by cellulitis. The provider determines that the abscess requires a simple incision and drainage procedure. After obtaining consent, the area is anesthetized, and a sterile incision is made to drain the pus. The wound is irrigated and dressed. The patient is monitored for improvement and may be scheduled for follow-up if needed. This procedure is typically performed in an office setting by a physician specializing in surgery, family medicine, or emergency medicine.
Coding Specifications
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Modifiers:
- Modifier
58: Used when a staged or related procedure or service is performed by the same physician during the postoperative period. For example, if a second incision and drainage is required due to persistent infection. - Modifier
59: Used to indicate a distinct procedural service, such as when multiple abscesses are treated in separate anatomical locations during the same encounter.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
208600000X | Surgery Physician |
207Q00000X | Family Medicine Physician |
207P00000X | Emergency Medicine Physician |
These specialties are commonly involved in performing incision and drainage of abscesses in outpatient settings.
Related Diagnoses
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L02.611: Cutaneous abscess of right axilla- Indicates a localized collection of pus in the right axilla, directly relevant for incision and drainage.
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L02.612: Cutaneous abscess of left axilla- Indicates a localized collection of pus in the left axilla, also directly relevant for the procedure.
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L02.91: Cutaneous abscess, unspecified- Used when the abscess location is not specified, but the clinical need for drainage is present.
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L03.311: Cellulitis of abdominal wall- Represents infection and inflammation of the abdominal wall, which may be associated with or lead to abscess formation requiring drainage.
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L03.90: Cellulitis, unspecified- Used for cases of cellulitis where the site is not specified; may be relevant if cellulitis is present with an abscess needing drainage.
Related CPT Codes
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10061: Incision and drainage of abscess; complicated or multiple- Used when the abscess is more complex or when multiple abscesses are drained. It is an alternative to
10060for more extensive cases.
- Used when the abscess is more complex or when multiple abscesses are drained. It is an alternative to
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10160: Puncture aspiration of abscess, hematoma, bulla, or cyst- Used when the abscess or similar lesion is managed by aspiration rather than incision. May be used as an alternative to
10060depending on clinical presentation.
- Used when the abscess or similar lesion is managed by aspiration rather than incision. May be used as an alternative to
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99213: Established patient office or other outpatient visit, level 3- Commonly used for evaluation and management of established patients prior to or after the procedure. May be billed in conjunction with
10060if documentation supports a separate E/M service.
- Commonly used for evaluation and management of established patients prior to or after the procedure. May be billed in conjunction with
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99203: New patient office or other outpatient visit, level 3- Used for evaluation and management of new patients. May be billed with
10060if a significant, separately identifiable E/M service is provided.
- Used for evaluation and management of new patients. May be billed with
National Reimbursement Benchmarks
For CPT code 10060, the national mean rate for Medicare is $133.09, while the BUCA (average commercial) mean rate is higher at $145.12. Commercial payers such as UnitedHealth Group and Cigna report even higher mean rates, at $191.55 and $188.62 respectively, compared to both BUCA and Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $14.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group and Cigna exhibit the widest dispersions, with ranges of $119.33 and $109.75 respectively, reflecting greater variability in commercial reimbursement.
The table and chart below present a detailed breakdown of national benchmarks for CPT code 10060 across major payers.
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