11/16/2022

Correct Coding for 5th Toenail Nail Avulsion-Severe Dystrophy and Total Nail Bed Excision

I performed a right fifth toenail total nail avulsion due to severe dystrophy discoloration (5+mm). After removal of nail, the nail was hollow with atypical nail bed. This was excised in total and sent for pathology for STM excision. At that point due to the significant soft tissue void, we then primary repaired the procedural site with simple interrupted suture. Coding assistance would be greatly appreciated. Thank you

Three procedure codes should be billed on the claim for this minor nail surgery:

• The first CPT code that would be billed is 11760 (Repair of nail bed), with -T9 as the primary modifier
• The second CPT code that would be billed is 11755 (Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure), with -59 as the primary modifier and -T9 as the second modifier
• The last CPT code that would be billed is 11730 (Avulsion of nail plate, partial or complete, simple; single), with -59 as the primary modifier and -T9 as the second modifier

With 3 procedures being performed on the same digit, documentation may be required to substantiate three separate services in the event that one or two lesser services are bundled.