Wiki Finger Laceration With Avulsion of Nail - Can I Assign CPT Code for Both?

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elizabeth24

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Patient presents to the ER with finger laceration. Stitches were used for repair. However, the nail was avulsed so it was removed. The physician stitched the nailbed as well. Can I assign a procedure code for both the nail and sutures of the skin or does the procedure on the nails trump the repair of the skin? I can 't find anything in the CPT book to help figure this out. Thanks in advance
 
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The procedures would have to qualify for a modifier such as XS, separate structure, as NCCI bundles the skin repair to the nail repair.

Hope that helps.
Cindy
 
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elizabeth24 said:
So would you just code the nail repair then? We use modifiers, but I am just not sure how to code.
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The answer is not straightforward. I think you have to look at whether there was one or two separate repairs (repair of nail bed with adsorbable sutures and repair of nonadjacent skin with non-adsorbable sutures).

I also thought about this more and you may want to check the individual payers guidance for use of modifiers 59 and X[E,P,S,U] as some interpret the modifiers differently (eg, allow use of XS for procedures on non-adjacent skin or recommend XU for nonadjacent areas of same organ system). Medicare appears to consider procedures on skin that is distal to or on the distal interphalangeal (DIP) joint included in a nail procedure on the same digit even when the procedures are different (eg, debridement of nails and paring of callus) and would not allow payment for both services on the same date.

Sorry there is no straightforward answer but that would just not be coding.:rolleyes:

Cindy
 
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Cynthia Hughes said:
The answer is not straightforward. I think you have to look at whether there was one or two separate repairs (repair of nail bed with adsorbable sutures and repair of nonadjacent skin with non-adsorbable sutures).

I also thought about this more and you may want to check the individual payers guidance for use of modifiers 59 and X[E,P,S,U] as some interpret the modifiers differently (eg, allow use of XS for procedures on non-adjacent skin or recommend XU for nonadjacent areas of same organ system). Medicare appears to consider procedures on skin that is distal to or on the distal interphalangeal (DIP) joint included in a nail procedure on the same digit even when the procedures are different (eg, debridement of nails and paring of callus) and would not allow payment for both services on the same date.

Sorry there is no straightforward answer but that would just not be coding.:rolleyes:

Cindy
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Thank you! LOL, you are totally right there, coding seems to never be 100% straightforward.
 
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