Billing for Post-Abscess I&D Follow-up Care
For a follow-up consultation 2 days after abscess I&D that involves removing packing and applying a dressing, you should bill for both the consultation (item 23) and a wound dressing procedure code.
Appropriate Billing Codes
When providing follow-up care for an abscess I&D that involves:
- Removing packing
- Applying a new dressing
- Assessing wound healing
The following billing approach is recommended:
- Consultation fee (already billed - item 23)
- Wound dressing procedure code - This should be added as the removal of packing and application of dressing constitutes a separate procedural service
Rationale for Additional Billing
The World Journal of Emergency Surgery guidelines indicate that packing removal is a distinct procedural component of abscess management 1. The procedure of removing packing and applying a new dressing requires:
- Clinical assessment of the wound
- Evaluation for potential complications
- Technical skill in removing packing without disrupting healing
- Selection and application of appropriate dressing materials
Evidence Supporting This Approach
Current guidelines for anorectal abscess management specify that packing typically remains in place for 48-72 hours and requires professional removal and reassessment 2. This follow-up care is considered a separate billable service from the initial I&D procedure.
The removal of packing is a critical step in the management of abscesses as:
- It prevents premature closure of the wound
- Allows assessment of healing progress
- Enables evaluation for potential complications like fistula formation
- Provides opportunity to break up any remaining loculations
Common Pitfalls in Billing Post-I&D Care
- Underbilling - Only charging for the consultation without including the procedural component of packing removal and dressing application
- Failure to document - Not adequately documenting the complexity and time involved in the wound care
- Missing associated services - Not billing for any additional services provided such as wound cultures or debridement if performed
Documentation Requirements
To support appropriate billing, ensure documentation includes:
- Size and location of the abscess cavity
- Condition of the wound upon removal of packing
- Any signs of complications (infection, premature closure, etc.)
- Type of dressing applied
- Patient instructions provided
- Follow-up plan
Follow-up Recommendations
Based on current guidelines, consider scheduling another follow-up visit in 5-7 days to:
- Assess wound healing progress
- Evaluate for potential fistula development (occurs in up to 33% of cases) 2
- Determine if additional interventions are needed
While recent evidence suggests that non-packing approaches may be less painful with similar outcomes 3, the current standard of care still includes proper management of packed wounds with appropriate billing for the services provided.