Podiatry Coding & Billing Alert

Key: Distinguish 11730, 11750 and 11765 from routine foot care.

As a podiatry practice, surgical treatment of nails are among the most common procedures you will code for. So knowing the CPT® codes — and the clinical circumstances allowing you to report them for full reimbursement — is critical.

Know the Codes

To treat ingrown nails, podiatrists commonly turn to a few CPT® procedures:

• 11730 (Avulsion of nail plate, partial or complete, simple; single) and 11732 (…each additional nail plate [List separately in addition to code for primary procedure])
• 11750 (Excision of nail and nail matrix, partial or complete [e.g., ingrown or deformed nail], for permanent removal)
• 11765 (Wedge excision of skin of nail fold [e.g., for ingrown toenail]).

Routine or not? Certain ingrown toenail treatments are considered part of routine foot care, and thus billable only with G0127 (Trimming of dystrophic nails, any number), 11719 (Trimming of nondystrophic nails, any number), and 11720-11721 (Debridement of nail[s] by any method…) for some payers.

“Treatment of simple uncomplicated or asymptomatic ingrowing nail by removal of the offending nail spicule, not requiring local anesthesia, is considered to be routine foot care,” according to a local coverage determination (LCD) from Medicare carrier Novitas. “Trimming, cutting, clipping, and debriding of a nail distal to the eponychium are also considered routine foot care. Routine foot care is only covered when certain systemic conditions are present. “

Understand the Procedures

Avulsion: CPT® codes 11730 and 11732 describe a single, simple, avulsion (removal) of the nail plate.  It can be either partial or complete, involving the removal of all of the nail or just part of the nail. The podiatrist administers a standard digital block, and uses a nail elevator, iris scissors or nail cutters to separate the nail plate from the nail bed, according to Arnold Beresh, DPM, CPC, CSFAC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va. Any small wounds are restored with a simple repair. 

Example: A patient presents with five ingrown toenails. The podiatrist completed simple avulsion on both sides of TA and T5, and one side of T1. Report 11730-TA (left foot, great toe); 11732 T5-59 (right foot, great toe); 11732 T1-59 (left foot, second digit). 11732 is used for each additional nail plate after the first (11730). 

Excision: CPT® code 11750 describes a procedure in which the podiatrist removes all or part of the toenail, including the nail plate, matrix, and lunula. To prevent a new nail from forming, the podiatrist uses phenol, electrocautrey, sodium hydroxide, or laser to destroy or permanently remove the nail matrix, says Beresh. 

Example: A patient presents for a follow-up of an ingrown toenail. The podiatrist finds that the patient now has two ingrown toenails — one on each foot. The physician removes both from each toe and also does a silver nitrate cauterization. Report 11750 appended by modifier 50 (Bilateral procedure).

Wedge excision: CPT® code 11765 describes removal of the inflamed tissue adjacent to the nail and a section of the nail itself, along the whole length of the nail. It is used as a treatment of a nail bed that has been injured due to laceration, crush, or avulsion, or for pain caused by an ingrown toenail. After administering local anesthesia, the physician makes an elliptical incision through the granulating or subcutaneous hypertrophied tissue of the affected nail groove. A wedge-shaped incision removes soft tissue from the nail margins. The wound is then closed with sutures to promote healing.

Example: A patient  is suffering from an ingrown left second-digit toenail. The podiatrist wedges the nail to treat the ingrowth, removes adjacent tissue, then packs it with Iodoform gauze. In this instance, report 11765.

Keep Your Documentation Straight

According to Medicare rules, for procedure codes 11730, 11732, 11750, and 11765 an operative report or complete detailed description of the procedure being performed is required. Failure to include the following information in the patient’s medical record could result in denial of the claim.

1. The patient’s chief complaint (e.g., painful toe)
2. Procedure being performed (making note to the nail margin involved)
3. Method of obtaining anesthesia (if not used, the reason for not using it)
4. A complete detailed description of the procedure
5. Postoperative observation and treatment of the surgical site (e.g., minimal bleeding, sterile dressing applied)
6. Postoperative instructions given to the patients and any follow-up care (e.g., soaks, antibiotics, follow-up appointments)

The medical record must be available upon request.