10140

Incision and drainage of hematoma, seroma, or fluid collection

CPT 10140 refers to the surgical incision and drainage of a hematoma, seroma, or other localized fluid collection within the skin or subcutaneous tissues. This procedure is a fundamental surgical intervention used to manage accumulations of blood (hematoma), serous fluid (seroma), or other non-purulent fluids that occur as a result of trauma, surgery, or inflammatory processes. A hematoma is a localized collection of blood outside the vascular system, which can become painful, cause tissue tension, or provide a medium for bacterial growth. A seroma is a collection of sterile fluid, often occurring in the dead space created during surgical dissections, such as after a mastectomy, hernia repair, or abdominoplasty. The procedure for 10140 involves several distinct clinical steps. After identifying the fluid collection through palpation or ultrasound and obtaining informed consent, the clinician cleanses the site with an antiseptic agent and administers local anesthesia. A scalpel is then used to make a deliberate incision through the epidermis and dermis, extending into the fluid-filled cavity. This is distinguished from simple aspiration (10160) because the incision allows for the evacuation of clotted blood, fibrin, or viscous fluid that cannot be easily withdrawn through a needle. The clinician may use blunt dissection or a hemostat to break up internal loculations. Following evacuation, the cavity is often irrigated with sterile saline. Depending on the volume of the collection and the risk of re-accumulation, a drain may be placed or the wound may be packed with gauze. The physician's documentation must specify the anatomical location, the characteristics of the fluid, and the method of drainage to support the use of this code.

Clinical Indications

  • Symptomatic hematoma causing significant pain or pressure
  • Postoperative seroma that is large or interfering with wound healing
  • Fluid collection at risk of secondary infection
  • Persistent fluctuance after blunt force trauma
  • Hematoma causing skin necrosis due to excessive tension
  • Obstetric surgical wound hematoma

Procedure Steps

  1. Confirm patient identity and procedure site
  2. Obtain informed consent for incision and drainage
  3. Cleanse the skin with antiseptic solution (e.g., chlorhexidine)
  4. Infiltrate the skin and subcutaneous tissue with local anesthetic
  5. Perform a linear incision over the most fluctuant area using a sterile scalpel
  6. Evacuate the blood or serous fluid through manual expression or suction
  7. Explore the cavity with a sterile instrument to break up loculations
  8. Irrigate the space with sterile saline or an antimicrobial solution
  9. Insert a drain or sterile packing material if necessary to prevent re-accumulation
  10. Apply a sterile dressing and provide wound care instructions

Coding Guidelines

  • Do not report 10140 for needle aspiration; use 10160 for puncture aspiration of a fluid collection
  • 10140 is intended for hematomas or seromas; for incision and drainage of an abscess, use codes 10060 or 10061
  • Local anesthesia is included in the procedural package and is not separately billable
  • If an E/M service is performed to decide the need for the procedure, append modifier 25 to the E/M code
  • If the procedure is performed in the global period of a previous surgery, use modifier 78 if it is related to the initial surgery or modifier 79 if unrelated
  • Report only one unit of 10140 unless multiple distinct fluid collections are drained in separate anatomical areas