11/23/2022
Correct Billing for 11750,11730 11732 and 11765-Different Toes
so now that we have 8 mos inbetween How do you bill if it is not the same date but a different toe? So you see the patient today for 11730 TA and a month later the patient comes in for a 11730 T5. Do you bill it as a 11730 T5 or a 11732 T5. Also if it was same scenario for a 11750 first was a TA and a month later it is a T5 will medicare deny the T5 for frequency and if they do do you just submit med notes?
Each nail surgery has a different limitation only if they are performed on the same digit/toe:
With the scenario above, you would bill 11730-T5.. the only time you would use the add on code is if they are being performed on the same day.
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.
Nail avulsions (11730 – 1st toe and each additional done on the same day are to be billed with the add on code of 11732 with that respective T Modifier)
11732-Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)
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.
Nail matrixectomies (11750) states it may only be performed once in a lifetime on the same toenail, therefore you would also bill 11750 with that respective T modifier.
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.
Wedge excisions for ingrown nails (11765) do not have a specified limitation if medical necessity can be justified by the provider
11765-Wedge excision of skin of nail fold (eg, for ingrown toenail)
Lay Description (Code):
The physician excises a wedge of restrictive skin in the nail fold to free an ingrown nail. The physician performs a wedge excision of the skin overlapping the lateral nail. The nail is examined and trimmed to encourage straight growth. The wound is dressed.
If the service is being done on a different toe, it can be done on the patient even if the procedure was previously done on another nail. To prevent any issues with global/frequency denials with insurance, the appropriate “T” modifier should be listed with each CPT code to show that different toes are being treated. Notes would only need to be submitted to justify medical necessity if a nail avulsion is being repeated on the same nail within the frequency global period, even if a different portion of the nail is being treated.