03/14/2017

Correct Billing for CPT Code 10061

What is the way to bill Medicare for the code 10061 -Bilateral? Code 10061 10061-XS was denied as well as 10061 TA 10061 T5

CPT 10061 was denied by Medicare for frequency because it may only be billed once per DOS per patient. The definition of the procedure code (incision and drainage of abscess — e.g., carbuncle, suppurativa hidrandenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia — complicated or multiple) means if the service was provided on two different toes, it would meet the criteria of “multiple” and would only be allowed to be billed once for payment. The second line item would need to be adjusted since it is not payable by the insurance carrier.