10140

💧 CPT 10140 — Incision and Drainage of Hematoma, Seroma, or Fluid Collection

Quick Reference

wRVU: 0.80 | Global Period: 010 (10 days) | Assistant Payable: ❌ No | Bilateral Indicator: 0

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📋 Clinical Description

CPT 10140 describes the incision and drainage of a non-infectious subcutaneous or soft tissue fluid collection — specifically a hematoma (blood collection), seroma (serous fluid accumulation), or other non-purulent fluid collection. A stab incision is made into the fluctuant collection, fluid is evacuated (manually or with suction), and the wound may be packed or a drain placed. This code is clinically and categorically distinct from 10060 and 10061 (which are for infectious/purulent abscesses): if the fluid is purulent, an abscess I&D code applies; if the fluid is blood or serous fluid in a non-infected setting, 10140 is correct.

A postoperative seroma or hematoma is the most common context for this code — particularly in surgical specialties where large skin flaps are raised (e.g., neck dissection, parotidectomy, thyroidectomy, mastectomy, scrotal/inguinal surgery). Seromas result from disruption of lymphatic channels and accumulation of protein-rich fluid in a dead space. Hematomas result from inadequate hemostasis or post-drain removal bleeding. If left untreated, both can impair wound healing, increase infection risk, and compromise surgical outcomes.

This procedure may be performed in the following clinical contexts:

• Post-surgical seroma (most common) — Accumulation of serous fluid under a skin flap after neck dissection, parotidectomy, thyroidectomy, or lymph node surgery; drained by aspiration or incision in the office.
• Post-surgical hematoma — Blood collection after scrotal surgery (Urology), neck surgery (OTO), or any subcutaneous procedure; may require formal incision if too viscous to aspirate.
• Post-traumatic hematoma — or soft tissue blood collection after blunt trauma; distinct from an auricular hematoma, which has a dedicated code (69000/69005).
• Traumatic seroma (Morel-Lavallée lesion) — Degloving injury creating a serosanguineous cavity between fascia and overlying fat; may be drained with 10140 when surgical intervention is chosen.
• Spontaneous fluid collection — Non-infectious subcutaneous fluid collection without a clear traumatic or postoperative etiology; document clinical findings and absence of infection.

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🔬 Anatomical & Procedural Considerations

Feature	Description	Coding Impact
Fluid type	Blood (hematoma) or serous fluid (seroma) — non-purulent	Critical: purulent fluid = abscess I&D (10060/10061); non-purulent = 10140
Approach	Stab incision or reopening of surgical wound	Both are captured under 10140; aspiration without incision → 10160
Drain placement	Penrose or closed suction drain may be left in place	Drain is bundled into 10140; no separate drain insertion code
Setting	Most commonly office or clinic post-discharge	Office-based drainage after neck dissection is a routine OTO scenario
Documentation	Fluid character, volume, and site must be documented	Required to distinguish from abscess and support correct ICD-10-CM pairing

Clinical Pearl

The most critical documentation element for 10140 is the character of the fluid — the procedure note must state “serosanguineous,” “serous,” or “blood/clot” rather than “purulent.” If the documentation is ambiguous, query the provider before selecting between 10140 and 10060/10061. In the OTO specialty, post-neck-dissection and post-parotidectomy seromas are among the highest-frequency clinical scenarios for this code. When the collection is drained by needle aspiration only (no incision), CPT 10160 (Puncture aspiration of abscess, hematoma, bulla, or cyst) is the appropriate code, not 10140.

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✅ Procedure Includes

• Pre-procedure assessment (bundled)
• Local or topical anesthetic administration (if used)
• Stab incision or wound reopening over the fluid collection
• Manual or suction-assisted evacuation of hematoma/seroma contents
• Blunt exploration of the cavity as needed
• Placement of drain (if applicable — bundled)
• Wound closure or packing as appropriate
• Dressing application
• Post-procedure wound care within the 10-day global window

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❌ Excludes / Do Not Report Together

Code	Description	Relationship to 10140
10060	I&D of abscess; simple or single	Purulent collection = abscess code; do not report 10140 for infected fluid collections
10061	I&D of abscess; complicated or multiple	Complicated purulent collection; mutually exclusive with 10140 for same site same session
10160	Puncture aspiration of abscess, hematoma, bulla, or cyst	When drainage is by needle/trocar aspiration without incision, 10160 applies — not 10140
20005	Incision and drainage of deep abscess or hematoma, soft tissue	Use 20005 when the hematoma is located in deep soft tissue (subfascial, intramuscular) — not in the skin or subcutaneous layer; 10140 is limited to skin/subcutaneous collections
E/M codes (992xx / 920xx)	Office visit, any level	Separately reportable only when modifier -25 is appended to the E/M code, documenting a significant, separately identifiable E/M service beyond the pre-procedure assessment

Warning

Bundling Alert — Global Period is 010, Not 000 or 090 10140 carries a 10-day global period. This creates a layered complexity in the postoperative setting: if 10140 is performed within the global period of the original surgery (e.g., neck dissection with a 90-day global), the 10140 may be classified as a complication and billed with modifier -78 (Unplanned Return to OR) or handled according to the originating procedure’s global rules. When 10140 itself has been performed and the patient returns within its own 10-day window for a related wound check, that follow-up is bundled.

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🌳 Code Tree — Surgery: Integumentary System, Incision and Drainage

10000–10180  Surgery: Integumentary System — Incision and Drainage
│
├── 10060–10061  Abscess Incision and Drainage
│   ├── 10060  I&D of abscess; simple or single  (Global: 010)
│   └── 10061  I&D of abscess; complicated or multiple  (Global: 010)
│
├── 10080–10081  Incision and Drainage of Pilonidal Cyst
│
├── ▶▶ 10140 ◀◀  I&D of hematoma, seroma, or fluid collection  ← YOU ARE HERE  (Global: 010)
│
├── 10160  Puncture aspiration of abscess, hematoma, bulla, or cyst  (Global: 000)
│
└── 20005  I&D of deep abscess or hematoma, soft tissues  (Global: 010)

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💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	0.80 (verify against current CMS MPFS for applicable year)
Global Period	010 (10 days)
Bilateral Indicator	0 — Not subject to bilateral reduction rules
Assistant Surgeon	❌ Not payable
Co-Surgeon	❌ Not applicable
Team Surgery	❌ Not applicable
PC/TC Split	❌ No — procedure code only (Indicator 0)
Modifier -51 Exempt	No
Anesthesia	Local infiltration or none; no separate anesthesia billing expected for office-based I&D

Bilateral Billing Rules

10140 has a bilateral indicator of 0 and is not subject to bilateral reduction rules. If seromas or hematomas are drained at two distinct anatomic sites in the same session (e.g., bilateral neck after bilateral neck dissection), document each site separately and report each code with appropriate anatomic documentation. Some MACs may require appending -59 or -XS to distinguish the second site.

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🏷️ Modifier Reference

Modifier	Name	When to Apply
-25	Significant, Separately Identifiable E/M	Applied to the E/M code — not 10140 — when an E/M is performed on the same date with documented evaluation beyond the pre-procedure assessment
-24	Unrelated E/M During Postoperative Period	Applied to E/M code when a patient returns within the 10-day global window of 10140 for an unrelated condition
-51	Multiple Procedures	When 10140 is performed alongside other surgical procedures in the same session; apply to the lower-valued code
-58	Staged or Related Procedure	When 10140 is planned or anticipated at time of original surgery and performed during the original procedure’s global period — requires documentation of planned/staged intent
-59	Distinct Procedural Service	When 10140 is performed at a distinct site from another procedure billed on the same date
-78	Unplanned Return to OR	When 10140 is performed for a postoperative complication (unplanned hematoma/seroma evacuation) during the global period of the original surgery
-79	Unrelated Procedure During Postoperative Period	When 10140 is performed during the global period of a prior, unrelated surgery
-52	Reduced Services	Procedure partially completed — document reason

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🩺 Common ICD-10-CM Pairings

Postoperative Hematoma / Seroma

ICD-10 Code	Description	HCC?	Clinical Notes
L76.01	Postprocedural hematoma of skin and subcutaneous tissue following a dermatological procedure	❌ No	Use when the prior procedure was dermatological (e.g., excision, Mohs); document the originating procedure
L76.02	Postprocedural seroma of skin and subcutaneous tissue following a dermatological procedure	❌ No	Most specific for post-dermatological seroma; document clearly in post-op note
T81.31XA	Disruption of internal wound, initial encounter	❌ No	Use when hematoma/seroma is associated with wound disruption; 7th character required
T81.89XA	Other complications of procedures, NEC, initial encounter	❌ No	Broad postoperative complication code; use when a more specific T81 code is not applicable; 7th character required

Traumatic Fluid Collection

ICD-10 Code	Description	HCC?	Clinical Notes
S00.03XA	Contusion of scalp, initial encounter	❌ No	Post-traumatic scalp hematoma; 7th character A for initial encounter
M79.89	Other specified soft tissue disorders	❌ No	Use for spontaneous or chronic seroma without a clear traumatic/postoperative etiology

External Cause / Surgery Encounter Codes

ICD-10 Code	Description	HCC?	Clinical Notes
Z48.01	Encounter for change or removal of surgical wound dressing	❌ No	Report as secondary code when the visit is also characterized by wound care; supports clinical picture
Z48.89	Encounter for other specified surgical aftercare	❌ No	Appropriate secondary code when patient presents for postoperative care of the seroma/hematoma in follow-up

Coding Specificity Reminder

The most commonly missed axis for 10140 pairings is the 7th character on T81 and S-code categories — always required. Additionally, postoperative hematoma/seroma codes (L76.01, L76.02) are specific to the type of originating procedure — verify which specialty performed the original surgery before assigning. When the originating surgery was not dermatological, T81-series codes are more appropriate. ICD-10-CM specificity requirements are not optional.

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🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder

CPT 10140 is performed primarily in the outpatient or office setting, most commonly as management of a post-surgical complication. When performed inpatient (e.g., post-parotidectomy hematoma requiring return to OR during inpatient stay), a corresponding ICD-10-PCS Drainage code is assigned. The principal diagnosis drives DRG grouping — a postoperative complication such as T81.31XA may group to MDC 9 or remain within the MDC of the original admission. CC/MCC status of the complication codes affects DRG tier.

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🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)

Note

Inpatient PCS coding for 10140 uses the root operation Drainage (9) — taking or letting out fluids and/or gases from a body part. Approach is External (X) for skin and subcutaneous level collections. Note: if the hematoma is subfascial or intramuscular (see 20005 territory), a different body system character applies.

PCS Code	Full Description	Applicable Scenario
0H9NXZZ	Drainage, Skin, Trunk, External Approach, No Device, No Qualifier	Post-surgical seroma/hematoma of trunk
0H95XZZ	Drainage, Skin, Neck, External Approach, No Device, No Qualifier	Post-neck dissection or post-thyroidectomy seroma (OTO)
0J980ZZ	Drainage, Subcutaneous Tissue and Fascia, Back, Open Approach, No Device, No Qualifier	Deeper subcutaneous seroma approached openly — less common

PCS Character Analysis — 0H95XZZ

Position	Character	Value	Definition
1	Section	0	Medical and Surgical
2	Body System	H	Skin and Breast
3	Root Operation	9	Drainage (taking or letting out fluids and/or gases from a body part)
4	Body Part	5	Skin, Neck
5	Approach	X	External
6	Device	Z	No Device
7	Qualifier	Z	No Qualifier

PCS Root Operation: Drainage (9) — Device Character

• Use Device Z (No Device) when a drain is NOT left in place.
• Use Device 0 (Drainage Device) when a Penrose or closed-suction drain is placed and left in situ.
• Leaving a drain in place changes the Device character from Z to 0 — this is the most commonly missed PCS nuance for drainage procedures. The drain must be documented as “left in place” in the operative note.

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📝 Coding Examples

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Example 1 — Office: Post-Parotidectomy Seroma (OTO)

Clinical Scenario: A 62-year-old female returns to the ENT clinic 8 days after right superficial parotidectomy for a benign pleomorphic adenoma. She presents with a soft, fluctuant swelling at the surgical site. The procedure note reads: “Stab incision made over the right parotid region; approximately 25 mL of clear serous fluid evacuated by manual expression; wound irrigated; iodoform packing placed.” No signs of infection.

Field	Code	Rationale
CPT	10140-78	I&D of seroma; modifier -78 applied because this is an unplanned return to address a complication (seroma) during the global period of the parotidectomy
PDx	L76.02	Postprocedural seroma of skin and subcutaneous tissue — most specific code for post-surgical seroma

Note

Modifier -78 is applied to 10140 because the seroma drainage is a complication of the prior surgery occurring within that procedure’s global period. The payment for 10140-78 is reduced to intraoperative value only under Medicare global surgery rules. Confirm the originating procedure’s global period before modifier selection.

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Example 2 — Outpatient: Post-Scrotal Surgery Hematoma (Urology)

Clinical Scenario: A 48-year-old male presents 3 days after bilateral varicocelectomy with a large, tense left scrotal hematoma causing significant discomfort. The surgeon makes a stab incision and evacuates approximately 40 mL of liquefied blood and clot. A Penrose drain is placed and left in situ. The procedure note documents “hematoma of left hemiscrotum; non-purulent; blood and clot evacuated; Penrose drain placed.”

Field	Code	Rationale
CPT	10140-78	I&D of hematoma, post-surgical; modifier -78 for unplanned complication management within global period of varicocelectomy
PDx	T81.31XA	Disruption of internal wound, initial encounter — hematoma disrupting the surgical site is most appropriately coded here; 7th character A for initial encounter
SDx	L76.01	Postprocedural hematoma of skin and subcutaneous tissue — add for specificity if payer accepts dual coding; verify against payer guidelines

Warning

When a drain is placed and left in situ, the PCS code changes — Device character shifts from Z (No Device) to 0 (Drainage Device). This is not relevant to CPT billing but is critical for inpatient facility ICD-10-PCS coding accuracy. Confirm operative note language: “drain left in place” vs. “drain removed at end of case.”

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Example 3 — Office: Post-Traumatic Subcutaneous Hematoma

Clinical Scenario: A 29-year-old male presents after blunt head trauma with a 5 cm tense scalp hematoma that has failed to resolve after 10 days of conservative management. The physician makes a stab incision and evacuates liquefied blood. No signs of infection are noted. No prior surgery was involved.

Field	Code	Rationale
CPT	10140	I&D of hematoma; no prior surgery global period involved; no modifier required
PDx	S00.03XA	Contusion of scalp, initial encounter — most specific traumatic origin code; 7th character A for initial encounter

Global period reminder:

10140 itself now carries a 10-day global — routine wound checks and packing changes after this traumatic hematoma drainage are bundled for 10 days. If the patient returns within 10 days for a completely unrelated complaint, use modifier -24 on the E/M and document the unrelated nature.

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⚠️ Common Coding Pitfalls

• Using 10140 for a purulent collection: If the procedure note documents purulent, cloudy, or “pus-like” fluid, the correct code is 10060 or 10061, not 10140. Fluid character documentation is non-negotiable for this distinction. When the note is ambiguous, query the provider.
• Using 10140 instead of 20005 for deep collections: 10140 covers skin and subcutaneous tissue-level collections. When the hematoma is subfascial or intramuscular, 20005 is the appropriate code. The operative note must document the anatomic layer of the collection.
• Confusing 10140 with 10160 (aspiration): 10140 requires an incision. Needle or trocar aspiration without incision is reported with 10160. Do not bill 10140 when the note describes only aspiration.
• Missing modifier -78 for post-surgical complications in global period: When 10140 is performed for a postoperative hematoma or seroma within the global period of the original surgery, modifier -78 is required. Omitting -78 results in denial because the payer’s system will see a new surgical procedure during an active global period.
• Failing to document drain placement as “left in place”: For PCS coding purposes (inpatient), the Device character changes when a drain is left in place. Operative notes that don’t specify whether the drain was removed or retained create a PCS coding ambiguity that must be queried.
• Defaulting to T81.89XA when a more specific complication code exists: L76.01 (postprocedural hematoma) and L76.02 (postprocedural seroma) are more specific than T81.89XA for skin and subcutaneous tissue complications. Assign the most specific code supported by documentation before defaulting to the NEC category.

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📎 Sources

¹ AMA CPT 2026 Professional Edition · ² CMS 2026 Medicare Physician Fee Schedule Final Rule · ³ CMS RVU26A Relative Value Files · ⁴ NCCI Policy Manual Chapter 1, CMS 2025–2026 · ⁵ ICD-10-CM Official Guidelines for Coding and Reporting FY2026 · ⁶ ICD-10-PCS Official Guidelines for Coding and Reporting FY2026 · ⁷ CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 12 — Global Surgery Policy · ⁸ AAPC Coding Edge — “Hematoma vs. Abscess: Know Your I&D Codes” (2024) · ⁹ Noridian Healthcare Solutions — Postoperative Complications and Global Surgery Policy