Wiki 11750 and 11730

[PCMOS]

My provider performed both procedures on the same DOS. I showed him in CodeX that 11730 is included with 11750. He, however, disagrees because the GSD lists 11730 as exposure/excision of nail bed/matrix. He states he performed an avulsion so he feels this is a misprint in CodeX and he can bill these procedures separately on that DOS. Input please?

 

[CodingKing]

These 2 codes cannot be billed together for the same nail. 11750 is a more intensive version of 11730. 11730 is performed so the nail can grow back. 11750 in addition to remove of the nail, the matrix/nailbed is killed off so the nail doesn't grow back.

Found this old presentation:
https://kindsvatterevents.com/AAPPM/2012BootCamp/FREDERICK - The Basics of Coding Pittsburgh.pdf

11730/11732 - Involves separation and removal of the entire nail plateor a portion of nail plate (including the entire length ofthe nail border to and under the eponychium)

11750 - requiring separation and removalof the entire nail plate or a portion of nail plate (includingthe entire length of the nail border to and under theeponychium) followed by destruction or permanentremoval of the associated nail matrix

Medicare for example doesn't even allow 2 codes if different sides of the same nail

The descriptions for CPT codes 11730, 11732 and 11750 indicate partial or complete. These CPT codes are representative of all services performed on that nail on a given date of service. When right or left borders of a nail are involved, a separate code should not be reported for each border.