11/21/2023

Billing for Nail Avulsion

When provider performs excision of ingrown nail border, is there a procedure code that can be billed. Dr. believes it's part of the office visit. To clarify here are two examples, copied from medical records. 1- I discussed appropriate treatment and nail cutting. discussed P&A procedure with post op course if not resolving and follow up. I excised the offending nail border in slant back technique. or 2-Discussed findings and treatment options with patient. Excision of the ingrown nail done and applied Ab dressing.

Based on the information provided above you can bill either of the following code(s):

11730- Avulsion of nail plate, partial or complete, simple; single

Lay Description (Code):

The physician avulses a nail plate partially or completely. A digital nerve block is used to numb the top of the digit. The physician bluntly dissects the nail plate from the nail bed. Any bleeding is cauterized. The digit is bandaged. Report 11730 if only one nail plate is removed. Report 11732 for each additional nail plate removed.

11750- Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;

Lay Description (Code):

The physician removes all or part of a fingernail or toenail, including the nail plate and matrix permanently. The nail plate is bluntly dissected and lifted away from the nail bed. The nail plate is detached from the matrix using a scalpel. The matrix is destroyed using chemical ablation, CO2 laser, or electrocautery. The wound is dressed loosely.

Unless the patient was seen for a different problem/issue, an E&M should not be billed with these procedures

However, if a local anesthetic was not used, then the above codes would not apply unless the patient had severe neuropathy.  It may be that you performed routine foot care and therefore would be subjected to RFC coverage guidelines for these services to be covered. In that case if not the patient is not eligible for RFC, then an E/M can be billed. Please note that one cannot continue to treat in this manner, as medical necessity would come into question.