Full Answer
I code 11750 at our facility. 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;
Ingrowing nail. L60.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2019 edition of ICD-10-CM L60.0 became effective on October 1, 2018. This is the American ICD-10-CM version of L60.0 - other international versions of ICD-10 L60.0 may differ.
Use 11730 for 'Avulsion' of the ingrown nail and nail plate for temporary removal. Use 11750 for Excisioin of the nail with 'matricectomy', which is done for permanent removal.
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.
0HBRXZZICD-10-PCS code 0HBRXZZ for Excision of Toe Nail, External Approach is a medical classification as listed by CMS under Skin and Breast range.
Acquired absence of other toe(s), unspecified side Z89. 429 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z89. 429 became effective on October 1, 2021.
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.
Routine foot care, removal and/or trimming of corns, calluses and/or nails, and preventive maintenance in specific medical conditions (procedure code S0390), is considered a non-covered service.
The correct amputation code that should be billed for an amputation of both the toe and metatarsal bone is CPT 28810 (Amputation, metatarsal, with toe, single). For each digit that is amputated, this code should be reported on the claim, or four lines.
28810 osteotomy is made through the metatarsal (ultimately in this case). What may be throwing you off is that the doc performed the disarticulation at the MTP joint first (28820) and then afterwards performed the osteotomy through the MT (28820).
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.
11750 is a more intensive version of 11730. 11730 is performed so the nail can grow back. 11750 in addition to remove of the nail, the matrix/nailbed is killed off so the nail doesn't grow back. The descriptions for CPT codes 11730, 11732 and 11750 indicate partial or complete.
Avulsion of a nail involves separation and removal of the entire nail plate or a portion of nail plate and an excision of the nail and the nail matrix is generally performed under local anesthesia requiring separation and removal of the entire nail plate or a portion of nail plate and is a permanent removal.
Answer: Yes. In the scenario you describe, both services are reportable under both CPT definitions of codes 11721 and 11056 and CMS NCCI edits and narrative guidelines.
So can CPT G0127 and 11720 be billed together? Yes, there is nothing preventing a podiatrist from billing them as one. As long as the forms are done properly and error-free, with the conditions and clearly marked out, there should be no problem with billing the two treatments together.
Onychogryphosis is a disorder of nail plate growth that is clinically characterized by an opaque, yellow-brown thickening of the nail plate with associated gross hyperkeratosis, elongation, and increased curvature. It is most common in older adults and patients with poor personal care.