ED Coding and Reimbursement Alert

Question: A patient reports to the ED with blood and pus under his left third and fourth digit toenails. The physician performs simple avulsion on each toe, and uses cautery to control bleeding. Notes indicate a level-two E/M service. Can I code the trephination separately for each nail?Pennsylvania SubscriberAnswer: You cannot code trephination for either repair, though you will be able to submit a CPT code for each avulsion. On the claim, report the following:11730 (Avulsion of nail plate, partial or complete, simple; single) for the first avulsion+11732 (... each additional nail plate [List separately in addition to code for primary procedure]) for the second avulsion99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) for the E/M serviceModifier 25 (Significant, separately identifiable evaluation [...]