ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code treatment of finger-nails and toenails? What's the difference between coding nail bed repairs, avulsion and tuft fractures?

Wyoming Subscriber
  Answer: All of these procedures are described with codes from the integumentary section of CPT.
 
Nail bed repair is described with 11760 (Repair of nail bed) and is used when the ED physician removes a damaged fingernail or toenail from the bed and then sutures the nail bed so it can heal cleanly.
 
Avulsion, which means "forcible separation," is a similar procedure that requires the physician to remove all or part of the nail from the bed and is assigned 11730* (Avulsion of nail plate, partial or complete, simple; single). If the nail has already been torn away, the coder should not report avulsion. No sutures are placed. If multiple nails are avulsed, coders should assign 11730* for the first nail and +11732 ( each additional nail plate [list separately in addition to code for primary procedure]) for each additional nail.
 
Note: The asterisk (*) means the code includes the surgical procedure only. The plus sign (+) signifies that the code should be added to the base code reported.
 
Simple tuft fractures include fractures of the distal phalanges (tips of the fingers). If the nail is damaged and repaired while the fracture is treated, CPT 26750 (Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each) should be assigned. If the wound causing the fracture is grossly contaminated and requires prolonged cleaning and removal of dead tissue, you may add a debridement code (e.g., 11044, Debridement; skin, subcutaneous tissue, muscle, and bone). However, if the injury is sutured, a wound repair code (e.g., 12042, Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) should be assigned instead of the debridement code, since debridement is included in wound repair. Finally, if the nail bed is involved, 11760 may be used in addition to the wound repair and fracture code.