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Nail removal with subsequent debridement

  1. Default Nail removal with subsequent debridement
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    I was wondering if I could get help on a coding question for a podiatry patient.
    The doctor removed all 5 left toenails at one time and chemically burned the nail beds with Phenol (not sure I am spelling that right).
    10 days later, still under post-op period, he did debridement of all 5 nail beds with dx code of ulcers. I questioned him about this and he said that the chemical treatment eats away the tissue and the patient has to come back to debride the dead tissue away.
    So, this would definitely be a staged procedure during the post op period but I am not sure how to capture all 5 debridements.
    Should I be using skin debridement (11040) with 58 modifier OR nail debridement (11720) with the 58 modifier. And do I code it once with 5 units or code it 5 times with the T1,2,3,4,TA modifiers? This is for Medicare.

  2. Default
    I am not well versed in this. But just initiate so that the right person will come out with the right answer!
    By the way, I have a question: The excision of nail and nail matrix partial or complete by any method x5 toes, code: 11750x 5, how much the global period; is it not 10days?
    if that is the scenerio, it would not meet the staging at the outset (off the global)Then debridement should be a different procedure- that too it is not meeting the debridement of nails code 11720. shouldn't it go for 1104x series?? with another E/M

    If it is within global period, and if physician intended to stage it with documentation, then it should go for the primary code with the -58
    If he did not originally intended for staging, this should be appended with -78 , with supported documentation.
    Both ways , I feel that it does not meet the requirements of nail debridement code (nails already off permanently.)

    could any one clean up the mess i made here !!!!???
    Thank you for your patience

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