10180 vs. 23930

Question:

Our surgeon did ORIF of a humeral shaft fracture. A few weeks later, the patient developed a postoperative infection. Diagnosis is 'Infected hematoma, left humerus'.

Excerpt from note:

“I removed all the sutures from the skin and the subcutaneous and immediately encountered a large amount of purulent material. This was completely evacuated. Multiple cultures were sent for culture. I debrided starting with the skin down to the level of bone and washed out with a combination of saline…...”

I considered submitting CPT 23930 Incision and drainage, upper arm or elbow; deep abscess or hematoma. CPT 10180 Incision and drainage, complex, postoperative wound infection could also work. Which one would be a better choice here, considering it was a musculoskeletal procedure?

Answer:

Thank you for asking KZA!

Some seemingly more straightforward cases that cross coding desks often provoke deep thought. KZA can appreciate reviewing and considering codes 10180 vs. 23930 for this scenario.

Based on the information in the excerpt from the note in the inquiry, KZA would assign CPT 23930.

The rationale: The tissues involved were deeper than the skin and deeper subcutaneous tissues for this incision and drainage. Additionally, debridement is considered included in CPT 23930.

*This response is based on the best information available as of 7/17/25.