ED Coding and Reimbursement Alert

Question: I would appreciate a discussion on nails as covered in the Integumentary system section of CPT. Specifically, when is a nail bed repair just that vs. a tuft fracture? When is it proper to charge an avulsion if the nail is mostly avulsed? I find these very confusing.

Madeleine Sorenson
Idaho Falls, Idaho

Answer: Knowing what procedures these codes report can be confusing. For now, here are the answers to the two questions you posed. First, the code for nail bed repair (11760) should be used when the physician removes the damaged nail from the nail bed and the nail bed is sutured into an appropriate position for healing, advises Charlene Day, BS, CMA, CMM, practice manager for Team Physicians, an emergency medicine practice group in Phoenix. A simple tuft fracture involves the fracture of the distal phalanges (tips of the finger).

Jan Loomis, director of coding and documentation for TeamHealth West Inc., an emergency physician staffing company based in Pleasanton, Calif., advises that to code an open tuft fracture, you would use 26750 (closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each) plus a code for debridement (e.g., 11044, debridement; skin, subcutaneous tissue, muscle and bone) if the wound is not sutured. If the repair code was sutured, then a wound repair code would be used. If the nail bed was involved, then the nail bed repair code (11760) would be used in addition to the code for the repair of tuft fracture, and wound repair.

As for reporting a code for nail avulsion (11730*, avulsion of nail plate, partial or complete, simple, single), the code for this procedure should be reported if the physician actually removes the nail from the nail bed, says Day. If that does not happen, or if the nail is technically already avulsed, then the physician does not actually perform a procedure and the code should not be used.

Answers to the reader questions in this issue were provided by: Caral Edelberg, CPC, CCS-P, president of Medical Management Resources Inc., an emergency medicine coding and consulting firm in Jacksonville, Fla.