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Nail procedures are done on fingers and toes. To pick the code you need two things from the note: which part of the nail was treated, and how many nails or digits.
Part 1 of 3
The nail unit
Picture it · which part of the nail?
- 1Nail plate. The hard nail you can see. Removing it (it can grow back) is avulsion.
11730+11732 - 2Nail bed. The skin under the plate. A blood clot here is drained with 11740; a torn bed is repaired (11760) or rebuilt with a graft (11762).
117401176011762 - 3Nail matrix. The root that grows the nail. Removing plate and matrix stops regrowth: a permanent removal.
11750 - 4Nail fold. The skin around the nail. A wedge of fold skin is cut out, often for an ingrown toenail.
11765
Once per session, or once per digit?
| Code | Procedure | How many times? |
|---|---|---|
| 11719 | Trimming of nondystrophic nails, any number | Once per session, however many nails |
| 11720 | Debridement of nail(s) by any method; 1 to 5 | Once per session: pick 11720 or 11721 |
| 11721 | Debridement of nail(s); 6 or more | Once per session |
| 11730 | Avulsion of nail plate, partial or complete, simple; single | First nail |
| +11732 | Each additional nail plate | Add-on, one per extra nail |
| 11740 | Evacuation of subungual hematoma | Per digit |
| 11750 | Excision of nail and nail matrix, for permanent removal | Per digit |
| 11755 | Biopsy of nail unit (plate, bed, matrix, folds); separate procedure | Per digit |
| 11760 | Repair of nail bed | Per digit |
| 11762 | Reconstruction of nail bed with graft | Per digit |
| 11765 | Wedge excision of skin of nail fold (e.g., ingrown toenail) | Per digit |
Drainage of an abscess around the nail (paronychia) isn't a nail code: use the incision and drainage codes. Nail debridement uses 11720–11721, not the wound debridement codes.
Avulsion vs. permanent removal
Both take the nail plate off. The difference is the matrix, the root that grows the nail:
- 11730 avulsion: the nail plate is removed (partly or completely) and the matrix is left, so the nail grows back.
- 11750 excision of nail and matrix: the matrix is removed too, so the nail can't grow back. That is why CPT calls it a permanent removal.
Part 2 of 3
Finger and toe modifiers
Picture it · finger and toe modifiers
Left handRight hand
Left footRight foot
A finger or toe modifier already tells the payer the work was on different digits, so 59 or XS isn't needed on top of it.
Examples
| Procedure | Codes |
|---|---|
| Avulsion of nail plate, right index and long finger | 11730-F6, 11732-F7 |
| Avulsion of nail plate, right great, second and third toe | 11730-T5, 11732-T6, 11732-T7 |
| Subungual hematoma drained, right ring and little finger | 11740-F8, 11740-F9 |
| Permanent nail removal, right long, ring and little finger | 11750-F7, 11750-F8, 11750-F9 |
MUEs on per-digit codes
When the same code repeats across several digits, check its MUE (the most units allowed per day) and its MAI:
- MAI 3: units above the MUE can be paid when the record supports them (often on appeal). Three fingers drained = three units of 11740 if the documentation shows three fingers.
- MAI 2: the limit is absolute. It can't be bypassed.
Check the current MUE table in your encoder; the values change quarterly.
Part 3 of 3
Separate procedure: the nail biopsy
11755 is labelled a separate procedure. That means it is normally part of a bigger procedure done at the same site, so:
- Same digit as a major nail procedure: don't report 11755. Permanent removal of the right long fingernail with a nail bed biopsy of the same finger = 11750-F7 only.
- Different digit: report it. Permanent removal of the right long fingernail and a biopsy of the right ring fingernail = 11750-F7, 11755-F8.
- Biopsy alone: one 11755 per digit, however many parts of that nail were sampled.
Nail bed repair and reconstruction
| Situation | Codes |
|---|---|
| Repair (sutures) and reconstruction with graft, same finger | 11762 only |
| Repair on the right ring, reconstruction on the right little finger | 11762-F9, 11760-F8 |
On the same digit, report only the reconstruction, the bigger procedure. On different digits, report both, and list the one with the higher RVU first (11762).
Permanent removal and wedge excision on the same toe
11750 (nail and matrix) and 11765 (wedge excision of the nail fold) have an NCCI edit: 11750 is column 1 and 11765 is column 2, with modifier indicator 1. On the same toe, report 11750 only, even though a modifier is "allowed."
If the wedge excision was on a different toe, report both with the toe modifiers (for example, 11750-T5, 11765-T6). The toe modifiers already show different digits, so 59 isn't needed.
End of the chapter: check what you remember
- The parts of the nail unit, and the code for each one
- Which codes are once per session and which are per digit
- Finger and toe modifiers, and why 59 isn't needed with them
- Same digit, two procedures: separate procedure, NCCI and which code wins