06/28/2022

Correct Billing for Ingrown Toenails/Patient Without PVD or DM Class Findings

Just a general question: Ingrown toenails. Regarding if this condition is treated on a patient w/o PVD or DM with class findings. Additional, treatment does not require local anesthesia. I would consider this routine foot care. I further assume that this condition would not be covered by insurance plans. Is this correct?

Ingrown nails can be a medically necessary diagnosis for podiatry care, even in the absence of a systemic condition. Coverage depends on the procedure that is being performed, and the type of insurance the patient has. Benefits should always be verified before a service is performed to confirm if a procedure will be covered by the patient’s plan. Below are the basic coverage criteria for common nail procedures (using Medicare guidelines):

• Nail avulsions (CPT codes 11730 & 11732) are minor surgery procedures where ingrown nails are a covered diagnosis for treatment (whether or not anesthesia is used) Article - Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures (A56766) (cms.gov)

 

• Nail debridement (CPT codes 11720 & 11721) and nail trimming (CPT code 11719 & HCPCS code G0127) are routine foot care services where in the absence of a systemic condition, this would be covered with specific ingrown nails as a primary diagnosis (onychogryphosis or onychauxis), as long as there is a covered secondary diagnosis reported (see details in the attached link) Article - Billing and Coding: Routine Foot Care and Debridement of Nails (A57759) (cms.gov)