How do you bill for toenail removal?

Procedure code 11750 (Excision of nail and nail matrix, partial or complete, [e.g., ingrown or deformed nail] for permanent removal) requires the removal of the full length or the entire nail plate, with destruction or permanent removal of the matrix by any means.

What is the ICD 10 code for toenail removal?


Excision of Toe Nail, External Approach, Diagnostic
ICD-10-PCS 0HBRXZX is a specific/billable code that can be used to indicate a procedure.

Is removal a toenail considered surgery?

So, at this point, your doctor may suggest surgery to remove the nail. It’s not a common surgery, but it’s an option when all else fails. When you have your nail taken out, a new one usually grows back. But nails grow slowly.

Does 11740 need a modifier?

Modifier -59 or modifier XS would be appended to CPT code 11740 because it is in column 2. In July 2019, Medicare will allow a more billing-friendly approach when utilizing modifiers -59, XE, XU, XS, and XP.

What modifier is used for 11730?

-The nail avulsion (CPT 11730) should be billed as the first procedure with L60. 0 as the primary diagnosis and L03. 032 as the secondary diagnosis, and the -TA modifier as primary.

What is the CPT code for toenail removal?

11750: Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; Lay Description: 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.

What is avulsion of the nail?

Losing a toenail or fingernail because of an injury is called avulsion. The nail may be completely or partially torn off after a trauma to the area. Your doctor may have removed the nail, put part of it back into place, or repaired the nail bed. Your toe or finger may be sore after treatment. You may have stitches.

Can 11730 and 11750 be billed together?

When you are trying to bill these two codes on the same toe (i.e., same anatomic modifier), the CPT 11730 avulsion will be disallowed as a component code. On the other hand, if you feel it is medically necessary to do both simultaneously on the same toe, then expect that only CPT 11750 will be covered.

How often can you bill 11750?

When the Medically Unlikely Edits (ie. MUEs) are accessed, the number is 6 which indicates that CPT code 11750 can be billed up to 6 times on a given date of service.

How Much Does Medicare pay for 11730?

When damage to the nail is extensive and removal is required, report it with CPT code 11730 (avulsion of nail plate, partial or complete, simple, single, 1.58 RVUs, Medicare $56.94).

What is the CPT code for repair of nail bed?


For repair of nail bed, report 11760 Repair of nail bed.

How much does it cost to get toenails removed?

The base price for a partial nail avulsion is $420. This implies removal of one problematic side on a single toe. When necessary, for an additional $70, both sides of the same toenail can be removed. If a second toe is being treated at the same time, this will cost an additional $170 for a single side of the 2nd toe.

What is the medical term for removal of a nail?

Reviewed on 3/29/2021. Matricectomy: the process of surgically or chemically destroying all or part of the base nail portion called the nail matrix. Complete destruction of the nail matrix results in permanent loss of that portion of the nail.

What is the medical term for surgical removal of toenail?

Matricectomy is the process of surgically, chemically, or electrically ablating or destroying the nail matrix. Complete excision of the viable nail matrix results in loss of the nail plate.

What are the toe modifiers?

Toe Modifier Fact Sheet

  • T1: Left Foot, Second Digit.
  • T2: Left Foot, Third Digit.
  • T3: Left Foot, Fourth Digit.
  • T4: Left Foot, Fifth Digit.
  • T5: Right Foot, Great Toe.
  • T6: Right Foot, Second Digit.
  • T7: Right Foot, Third Digit.
  • T8: Right Foot, Fourth Digit.

What is TA modifier?

TA Left foot, great toe. T1 Left foot, second digit.

How often can you bill 11730?

per 24 months

Medicare will allow ten services per beneficiary per 24 months for CPT codes 11730 and/or 11732. Payment for services beyond this number will require medical review of patient records to determine medical necessity.

What does CPT code 10061 mean?

incision and drainage of abscess

The first code in the CPT series for incision and drainage, CPT 10060-10061, defines the procedure as “incision and drainage of abscess (carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single and complex or multiple.”

What is the modifier for right great toe?

Modifiers TA, T1-T9

Modifier Brief Description
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit

What is the ICD 10 code for ingrown toenail?

L60. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

What is the medical term for ingrown toenail?

Ingrown toenail (onychocryptosis) is a fairly frequent problem resulting from either growth of nail fold inwards into the nail bed or abnormal embedding of the nail plate into the nail groove, causing significant discomfort.

Does CPT code 11750 require a modifier?

When billing for non-covered services, use the appropriate modifier. The description of CPT codes 11730, 11732 and 11750 indicates partial or complete avulsion or excision of a nail plate.

What is the main term for ingrowing toenail left great toe?

An ingrown nail, also known as onychocryptosis from Greek: ὄνυξ (onyx) ‘nail’ and κρυπτός (kryptos) ‘hidden’, is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed.

What does a podiatrist do for an ingrown toenail?

A podiatrist will remove the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails.

What are pincer nails?

Pincer nail is a condition characterized by excessive transverse nail curvature, progressively pinching the nail bed distally. It is quite common in the toenails of adults, while they are rare in the fingernails, where they are related to abnormalities of the distal phalanx (exostosis or arthritis).