02/22/2021

Correct Coding for Severe Ingrown Toenail with Significant Hypertrophic Infectious Tissue

If you have a patient with a severe ingrown toenail with significant hypertrophic infectious tissue clinically diagnosed as a pyogenic granuloma what is the best way to code for the procedure? We performed a Partial nail avulsion + ST mass excision using ST nipper in total

The partial nail avulsion should be billed with procedure code 11730 (Avulsion of nail plate, partial or complete, simple). The excision of the pyogenic granuloma is part of doing the ingrown nail procedure

11730 or a 11750 if used phenol or other matrixectomy procedure. 

Code Description

 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.

Coding Tips

Report 11732 in addition to 11730. For drainage of a paronychia or onychia abscess, see 10060–10061. It is inappropriate to report supplies when these services are performed in an emergency room. For physician offices, supplies may be reported with the appropriate HCPCS Level II code. Check with the specific payer to determine coverage.

Code Description

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.

Coding Tips

This procedure may be reported only once per digit. A partial excision of the nail does not count as two separate procedures, even when the partial excision requires two incisions (medial and lateral aspects). When a pinch graft is required, see 15050. Surgical trays, A4550, are not separately reimbursed by Medicare; however, other third-party payers may cover them. Check with the specific payer to determine coverage. For wedge excision of the skin of a nail fold (e.g., for ingrown toenail), see 11765. For avulsion of a nail plate, see 11730–11732. For handling or conveyance of a specimen transported to an outside laboratory, see 99000.