CPT code 25031: Incision and drainage, forearm and/or wrist; bursa

Key takeaways

CPT code 25031 describes incision and drainage of a bursa in the forearm and/or wrist. It applies when the bursa becomes infected or inflamed and needs surgical drainage.

CMS assigns CPT 25031 a 090-day global period, which makes it a major surgery for billing purposes. Routine follow-up care for 90 days after the procedure is bundled into the base payment.

CMS values 25031 at about 11.47 total RVUs, or roughly $364, and that payment does not change between office and facility settings.

Missing the laterality modifier (LT or RT) and billing a same-day E/M visit without modifier 57 are the two most common denial triggers.

Practice management software like Pabau flags NCCI edits, prompts for the required modifiers, and submits CPT 25031 claims through the Claim.MD clearinghouse.

CPT code 25031 is maintained by the AMA and carries the official descriptor: Incision and drainage, forearm and/or wrist; bursa. It sits within the Musculoskeletal System section of the CPT codebook, specifically under Incision Procedures on the Forearm and Wrist (codes 25000-25040).

The procedure involves a surgical incision into an inflamed or infected bursal sac in the forearm or wrist. The surgeon then drains the accumulated fluid or purulent material and irrigates the space.

The bursa is a fluid-filled sac that cushions tendons, bones, and skin. When it becomes infected or acutely inflamed, conservative treatment often fails and surgical drainage becomes necessary.

Key code facts at a glance:

• Code: 25031
• Official descriptor: Incision and drainage, forearm and/or wrist; bursa
• CPT section: Musculoskeletal System, Forearm and Wrist, Incision
• Code type: Surgical (not an evaluation and management code)
• Global period: 090 days (major surgery)
• Typical setting: Office (POS 11), outpatient hospital (POS 22), ambulatory surgery center (POS 24)

Clinical indications for CPT code 25031

Not every case of bursitis warrants 25031. Payers require documented medical necessity before approving the claim, and that means the clinical record must show conservative treatment either failed or was contraindicated. Surgical drainage claims are reviewed on that evidence, so the note has to name the non-surgical options that were tried or ruled out.

The three primary indications for 25031 are:

• Septic bursitis: Bacterial infection of a forearm or wrist bursa, confirmed or suspected based on clinical presentation (warmth, erythema, fluctuance, fever). This is the most common indication.
• Infected traumatic bursitis: Post-injury bursitis complicated by secondary infection, where aspiration and antibiotics have not resolved the infection.
• Acute inflammatory bursitis unresponsive to conservative care: Severe non-infectious bursitis where aspiration, NSAIDs, corticosteroid injection, or referral to a physical therapy practice has failed.

The operative note must document the specific anatomical site, forearm or wrist. It must confirm the bursal origin of the collection, ruling out an abscess, hematoma, or tendon sheath. It must also state why non-surgical management was insufficient.

Where the conservative care happened at a primary care practice, pull that history into the note instead of referring to it. A payer reviewing the claim sees your record, not the referring one.

ICD-10 codes commonly paired with CPT code 25031

Pairing the wrong diagnosis code with CPT 25031 is a fast track to a medical necessity denial. The ICD-10-CM codes below are the most commonly used pairings, verified against current coding guidelines. Laterality is built into many of these codes, which ties directly to the laterality modifier requirement on the CPT side of the claim.

Cross-referencing these against the CDC/NCHS ICD-10-CM web tool before submission confirms you are using a billable, non-excluded code.

One distinction matters more than the rest. The L02.5xx codes describe cutaneous or subcutaneous abscesses of the hand, not bursitis. If the collection is bursal in origin, the M70.1x series is more accurate.

Document that the collection arose from the bursal sac rather than the skin or soft tissue. That single line supports the diagnosis code and defends against downcoding to a soft-tissue abscess code.

CPT code 25031 modifiers

Modifiers tell the payer about special circumstances that affect how the procedure was performed or billed. Applying the wrong modifier, or omitting a required one, is among the most common reasons CPT 25031 claims are delayed or denied. Laterality modifiers matter most, because 25031 describes a unilateral procedure that could have been performed on either side.

Because 25031 is a major surgery, the decision-for-surgery visit takes modifier 57, not modifier 25. Modifier 25 belongs on E/M services billed with minor procedures that carry a 000-day or 010-day global period. Sending a 25031 claim with modifier 25 on the same-day E/M is a routine denial.

Modifier 59 carries compliance risk if misapplied. CMS NCCI guidance holds that modifier 59 belongs only on a documented distinct service. The documentation has to separate it from the procedure it is being unbundled from, and overuse is an audit trigger.

CPT code 25031 reimbursement and RVU values

Reimbursement for CPT 25031 varies by payer and by geographic location. The Medicare Physician Fee Schedule, maintained by CMS, is the standard reference for RVU values and baseline payment rates. These figures are revised annually, so verify them against the CMS look-up tool before using them in contract negotiations.

One quirk sets 25031 apart from most surgical codes. CMS assigns it a single practice expense value, so the office rate and the facility rate come out the same. Place of service still decides who bills the overhead, but it does not move the physician payment.

Note: These figures follow the CMS physician fee schedule relative value file for January 2025 and are subject to annual revision. Geographic adjustment factors will shift the actual payment by location.

Global period for CPT code 25031

CPT 25031 carries a 090-day global period, which CMS classifies as major surgery. The global package covers the day before the procedure, the day of the procedure itself, and the 90 days that follow. Routine postoperative care from the operating surgeon during that window is already paid for in the surgical fee.

A 90-day window is longer than most incision and drainage codes carry, so it is worth verifying at the source. The CMS national physician fee schedule relative value file lists 25031 with GLOB DAYS = 090. The sibling forearm and wrist codes 25000, 25020, 25028, and 25035 carry the same 090 assignment.

• Bundled (cannot bill separately): Routine wound checks, suture removal, dressing changes, and postoperative visits related to the drainage through day 90
• Separately billable: An unrelated problem during the window (modifier 24), an unrelated procedure (modifier 79), or a planned staged procedure (modifier 58)
• Complications: A return to the operating room to treat a complication of the drainage is billable with modifier 78
• Decision for surgery: The visit at which the surgeon decides to operate takes modifier 57, on the day before or the day of surgery
• Counting the window: The day of surgery is day 0, and the global period closes 90 days after the procedure date

Mapping that window onto the calendar changes front-desk behavior as much as billing. Every follow-up booked in the next three months needs checking against the surgery date before it is coded as a separate visit.

Place of service for CPT code 25031

CPT 25031 is payable in three settings, and the physician payment is the same in each:

• POS 11 (Office): The most common setting for a straightforward septic bursitis drainage.
• POS 22 (Outpatient Hospital): The hospital bills its own facility fee separately from your claim.
• POS 24 (Ambulatory Surgery Center): The ASC bills separately for the facility fee.

Bill the POS code that matches where the service was actually performed. Mismatching POS on the claim is a fraud and abuse risk, not just a billing error.

NCCI edits and bundling rules for CPT 25031

The National Correct Coding Initiative (NCCI) publishes bundling edits that tell payers which code combinations are considered redundant when billed together. For CPT 25031, the key bundling rule covers evaluation and management (E/M) codes on the same date of service. Those E/M visits are bundled when they relate directly to the decision to perform the procedure.

Among the common denial codes, NCCI-related edits rank in the top five reasons surgical claims fail on first submission.

Bundling principles for 25031:

• Same-day E/M visits: The E/M is bundled into the procedure when the physician evaluates the patient and drains the bursa on the same day. Modifier 57 unbundles it, but only when that visit is the decision for surgery.
• Unbundling with modifier 59: Modifier 59 overrides an NCCI edit only when the note establishes a genuinely distinct procedural service.
• Related codes that should NOT be billed together: Do not bill CPT 25000 and 25031 for the same anatomical site on the same date. CPT 25000 covers incision of the tendon sheath, and only documented separate procedures justify billing both. A denial management protocol for forearm surgical claims gives your team an appeals path when the edit fires anyway.

Documentation requirements for CPT code 25031

Every element below needs to appear in the operative note before the claim is submitted. Payers audit musculoskeletal surgical claims closely. A note that is vague about anatomical site, collection type, or medical necessity will trigger a denial or a documentation request.

A superbill template built for forearm I&D procedures stops your billing team from chasing the chart for missing details. A structured progress-note format, such as a PIE note, does the same job for the follow-up visits inside the global window.

• Anatomical site: Explicitly state forearm or wrist, and document laterality (right or left)
• Type of collection: Confirm the collection is bursal in origin, not a soft-tissue abscess or tendon sheath effusion
• Infection confirmation: Document clinical signs (erythema, warmth, fluctuance, fever, elevated WBC) and/or culture results where available
• Medical necessity justification: State why surgical drainage was required (failed aspiration, failed antibiotic therapy, abscess formation, rapidly worsening presentation)
• Procedure performed: Describe the incision location, drainage technique, irrigation, and any packing or wound care performed
• Follow-up plan: Record the postoperative plan across the 090-day global period, so the practice does not bill follow-up visits that are already covered

Practices using clean claim protocols catch these omissions before the claim goes out, rather than after the denial comes back. Consistent templating is the most reliable fix for recurring documentation-related denials.

Electronic remittance advice data shows billing teams which documentation element payers are flagging on denied claims. The team can then correct that element across every future submission.

Related CPT codes for incision and drainage procedures

Selecting the wrong code from the forearm incision family is a common upcoding or downcoding error. The table below maps the sibling codes to 25031 and defines the key differentiator for each. When the operative note clearly describes a bursal collection in the forearm or wrist, 25031 is correct. A deeper collection, a different structure, or a different anatomical level points to a different code.

All five codes in this table carry a 090-day global period, so switching codes within the family does not change the postoperative window. The differentiator is always the anatomical structure named in the operative note. Move outside the forearm and wrist range and the region decides the code, from 26170 in the palm to 25441 at the distal radius.

25031 vs 25035: Key differences

The confusion between 25031 and 25035 is understandable, because both involve incision procedures in the forearm and/or wrist. The defining distinction is the target tissue. CPT 25031 drains a bursal sac. CPT 25035 involves an incision into the bone cortex, and it is used for periosteal or osseous infections such as osteomyelitis.

In practice: If the operative report mentions “bursa,” “bursal sac,” or “bursectomy,” use 25031. If it mentions “cortex,” “periosteum,” “osteomyelitis,” or “bone,” 25035 may be appropriate. Billing 25035 for a bursal drainage procedure constitutes upcoding.

Both codes carry a 090-day global period, so the post-op billing window is identical and offers no help in telling them apart. Only the operative note’s description of the target tissue separates them.

Common coding errors with CPT code 25031 and how to avoid them

Four denial patterns account for most rejected CPT 25031 claims. Each one has a specific fix that can be built into your pre-submission workflow.

• Error 1: Missing laterality modifier. Billing 25031 without LT or RT is a top denial trigger. Payers that require laterality modifiers will auto-deny the claim. Fix: Add modifier LT or RT to every 25031 claim, and build a hard stop in your billing system that flags the omission before submission.
• Error 2: Wrong anatomical structure coded. Billing 25031 for a soft-tissue abscess, a tendon sheath, or a deep hematoma triggers a medical necessity denial on audit. Those cases belong to CPT 10060 or 10061, CPT 25000, and CPT 25028 respectively. Fix: Require coders to confirm the word “bursa” or “bursal” appears in the operative note before selecting 25031.
• Error 3: Using modifier 25 instead of modifier 57 on a same-day E/M. Modifier 25 pairs with minor procedures. Because 25031 carries a 090-day global period, the decision-for-surgery visit needs modifier 57 instead. Fix: Set your billing rules so a same-day E/M billed with 25031 prompts for 57, not 25.
• Error 4: Billing routine post-op visits separately during the 090-day global period. Office visits related to the drainage stay bundled for a full 90 days after surgery, not 10. Fix: Write the global period end date into the scheduling record on the day of surgery. The front desk then knows which follow-ups cannot be billed.

How practice management software supports CPT 25031 billing

Billing forearm I&D procedures by hand, across payer contracts with different modifier requirements and NCCI edit tables, creates a predictable failure rate. Practices that connect clinical documentation to the billing workflow catch errors at the point of coding, not after the denial lands.

Pabau’s claims management software connects clinical notes to the billing workflow. CPT and ICD-10 code selection then happens in context, rather than as a separate manual step.

The Claim.MD integration handles electronic claim submission to thousands of US payers and runs real-time eligibility verification. It also returns electronic remittance advice, the ERA or 835 file. The billing team then sees denial reasons as coded CARC explanations rather than generic rejection notices.

For CPT 25031, a missing laterality modifier or an NCCI edit conflict surfaces before the claim reaches the payer. The alternative is finding out 30 days later, as a denial.

The practical workflow runs in a few steps. The clinician completes the operative note. The billing team selects CPT 25031 and the matched ICD-10 code within Pabau. The system checks the claim against payer-specific modifier requirements and NCCI edits, then routes the clean claim through Claim.MD.

Denials that do occur come back with machine-readable CARC codes, which is faster to work than an unstructured EOB letter. Practices comparing medical billing software gain the most from an integrated clearinghouse, because integration removes the manual handoff where most CPT 25031 errors originate.

Streamline your CPT 25031 billing workflow

Pabau’s claims management tools flag NCCI edits, prompt for laterality modifiers, and submit clean claims through the Claim.MD clearinghouse. Forearm I&D procedures get paid faster, with fewer follow-up calls.

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Conclusion

One line in the operative note settles the coding decision for 25031. It has to name the bursa and the side that was treated. Get that line right and the modifier, the diagnosis code, and the claim all follow from it.

The 90-day window is where the money quietly leaks. A practice that writes the global end date into the schedule on the day of surgery stops billing follow-ups that are already paid. Nothing about the payment rate changes with the setting, so the only variables left are documentation and timing.

That makes 25031 a systems problem more than a coding problem, and systems are worth automating rather than remembering. Book a demo to see how Pabau handles musculoskeletal surgical claims from note to payment.

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