Anatomy of Nails

 

 

 

Nails are composed of several parts, including the nail plate (the visible, hard part of the nail), the nail bed (the skin underneath the nail plate), the cuticle (the thin layer of skin at the base of the nail), the lunula (the half-moon-shaped area at the base of the nail), and the nail matrix (the tissue beneath the cuticle responsible for nail growth).

 

Function: Nails protect the fingertips and toes from injury and help with delicate tasks like picking up small objects. They also provide support for the soft tissues at the tips of the fingers and toes.

Growth: Nails grow from the nail matrix, a specialized area of cells near the base of the nail. On average, fingernails grow at a rate of about 3 millimeters per month, while toenails grow more slowly.

Health Indicators: The condition of the nails can sometimes be an indicator of a person’s overall health. Changes in nail color, texture, or growth patterns may be associated with underlying medical conditions, nutritional deficiencies, or trauma.

Nail Disorders: There are various nail disorders and diseases that can affect the appearance and health of the nails. These include fungal nail infections, ingrown nails, nail psoriasis, and nail trauma, among others. Some disorders may require medical treatment or intervention by a dermatologist or other healthcare provider.

Nail Care: Proper nail care involves keeping the nails clean, trimming them regularly, and avoiding habits that can damage the nails, such as biting or using them to open packages. Nail care is also important to maintain the health and appearance of the nails.

Nail Procedures: In some cases, medical procedures may be performed on the nails. For instance, ingrown toenails may require minor surgical intervention, while fungal infections may be treated with medications or laser therapy.

 

CPT CODE -11719 Trimming of non-dystrophic nails, any number

 

CPT code 11719 is used for the “Trimming of Non-dystrophic Nails.”

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Trimming of Nondystrophic Nails.” This CPT code should not be used for other nail conditions or dystrophic nails.

 

Medical Necessity: The procedure should be medically necessary. The trimming of nails is typically performed for individuals who have difficulty managing their nail care due to various conditions.

 

Documentation: Proper documentation of the procedure is essential for coding accuracy. The medical record should indicate the need for nail trimming and the procedure itself.

 

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

 

Example:

 

Let’s consider an example where a patient, Mr. Smith, has diabetes, which has resulted in thickened and hard-to-manage toenails. He comes to a podiatrist’s office for the trimming of his non dystrophic toenails.

 

The podiatrist assesses Mr. Smith’s condition, notes the medical necessity of trimming his toenails, and documents this in the patient’s medical record.

The podiatrist performs the nail-trimming procedure. In the medical billing and coding process, the appropriate CPT code for the procedure, 11719, is used to bill for the service.

 

 

CPT CODE  11720 Debridement of nail(s) by any method(s); 1 to 5

 

CPT code 11720 is used for “Debridement of Nails.” This CPT code is typically used in medical billing and coding to represent the specific procedure of removing diseased or damaged tissue from the nails. Here are some coding guidelines and an example of how to use CPT code 11720:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Debridement of Nails.” This CPT code should not be used for other nail conditions or procedures.

 

Medical Necessity: The procedure should be medically necessary. Debridement is typically performed when there is diseased or damaged nail tissue that needs to be removed to alleviate pain, prevent infection, or aid in the treatment of a nail disorder.

 

Documentation: Proper documentation of the procedure is essential for coding accuracy. The medical record should indicate the need for nail debridement and the extent of the debridement performed.

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the CPT code for additional information or to indicate special circumstances.

Example:

 

Let’s consider an example where a patient, Ms. Johnson, has an ingrown toenail on her big toe, which has become infected and is causing severe pain. She visits a podiatrist’s office for the debridement of the affected toenail.

The podiatrist assesses Ms. Johnson’s condition, notes the medical necessity of debriding the ingrown toenail due to infection and pain, and documents this in the patient’s medical record.

The podiatrist performs the nail debridement procedure to remove the diseased and infected tissue from the ingrown toenail.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11720, is used to bill for the service.

 

CPT CODE 11721   Debridement of the nail(s) by any method 6 or more

 

CPT CODE  11730 Avulsion of the nail plate, partial or complete, simple; single

 

CPT code 11730 is used for “Avulsion of Nail Plate.” This CPT code represents the procedure of removing a nail plate from the nail bed. Here are some coding guidelines and an example of how to use CPT code 11730:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Avulsion of Nail Plate.” This CPT code should be used when a nail plate needs to be removed from the nail bed, such as in cases of ingrown nails, traumatic injuries, or severe fungal infections.

 

Medical Necessity: The procedure should be medically necessary. Avulsion of the nail plate is typically performed to alleviate pain, prevent infection, or aid in the treatment of nail conditions.

Documentation: Proper documentation of the procedure is essential for coding accuracy. The medical record should indicate the need for nail plate avulsion, the nail involved, and the extent of the avulsion performed.

 

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Mr. Anderson, has a severe ingrown toenail on his left big toe, which is causing excruciating pain and infection. He visits a podiatrist’s office for the avulsion of the ingrown nail plate.

The podiatrist assesses Mr. Anderson’s condition, notes the medical necessity of avulsing the ingrown nail plate due to pain and infection, and documents this in the patient’s medical record.

The podiatrist performs the nail plate avulsion procedure to remove the affected portion of the nail plate from the nail bed.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11730, is used to bill for the service.

 

CPT CODE ✚ 11732 for each additional nail plate (List separately in addition to code for primary procedure) (Use 11732 in conjunction with 11730)

 

CPT CODE 11740 Evacuation of subungual hematoma

 

CPT code 11740 is used for the “Evacuation of Subungual Hematoma.” This CPT code is used when a healthcare provider performs a procedure to drain or remove a collection of blood (hematoma) trapped beneath the fingernail or toenail. Here are some coding guidelines and an example of how to use CPT code 11740.

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Evacuation of Subungual Hematoma.” This CPT code should be used when a subungual hematoma requires evacuation, typically due to trauma or injury to the nail or nail bed.

Medical Necessity: The procedure should be medically necessary. Evacuation of a subungual hematoma is performed to relieve pain and pressure caused by the trapped blood or to prevent complications such as nail damage or infection.

Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should indicate the need for evacuating the subungual hematoma and the extent of the procedure performed.

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

 

Example:

 

Let’s consider an example where a patient, Mr. Davis, has slammed his thumb into a car door, resulting in a subungual hematoma under his nail, causing severe pain and pressure.

Mr. Davis seeks medical attention at an urgent care center, and the healthcare provider assesses his condition, notes the medical necessity of evacuating the subungual hematoma due to pain and pressure, and documents this in the patient’s medical record.

The healthcare provider performs the evacuation of the subungual hematoma, typically by making a small hole in the nail to release the trapped blood.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11740, is used to bill for the service.

 

CPT CODE 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal

 

CPT code 11750 is used for the “Excision of Nail and Nail Matrix.” This CPT code is used when a healthcare provider performs a procedure to remove a portion or the entire nail and the nail matrix. Here are some coding guidelines and an example of how to use CPT code 11750:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Excision of Nail and Nail Matrix.” This code should be used when a portion or the entire nail and its associated nail matrix are excised for medical reasons, such as in cases of chronic nail infections, tumors, or severe nail disorders.

Medical Necessity: The procedure should be medically necessary. Excision of the nail and nail matrix is typically performed when conservative treatments have failed, and the condition of the nail and nail matrix is affecting the patient’s health or causing significant pain or discomfort.

Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should indicate the need for the excision, the specific nail involved, and the extent of the procedure performed.

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

 

Example:

 

Let’s consider an example where a patient, Mrs. Hernandez, has a severe and chronic nail infection in her right big toe, which has caused significant pain and discomfort, and conservative treatments have been unsuccessful.

Mrs. Hernandez consults with a podiatrist, who assesses her condition and documents the medical necessity of excising the nail and nail matrix due to the chronic infection and pain.

The podiatrist performs the excision procedure, removing the infected nail and the associated nail matrix to ensure complete removal of the source of infection. In the medical billing and coding process, the appropriate CPT code for the procedure, 11750, is used to bill for the service.

 

CPT CODE  11755 Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)

 

CPT code 11755 is used for the “Biopsy of Nail Unit.” This CPT code is utilized when a healthcare provider performs a biopsy to sample tissues or cells from the nail unit. Here are some coding guidelines and an example of how to use CPT code 11755:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Biopsy of Nail Unit.” This CPT  code should be used when a biopsy is necessary to evaluate nail and nail unit abnormalities, such as nail tumors, growths, or unusual nail conditions.

 

Medical Necessity: The biopsy should be medically necessary. Biopsies are typically performed when there is a diagnostic uncertainty or suspicion of a significant nail disorder that requires further examination.

 

Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should indicate the reason for the biopsy, the nail or nail unit involved, and the technique used.

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

 

Example:

 

Let’s consider an example where a patient, Mr. Johnson, presents to a dermatologist with a pigmented lesion on his thumbnail. The dermatologist suspects a potential nail unit tumor and decides to perform a nail unit biopsy for diagnostic purposes.

The dermatologist assesses Mr. Johnson’s condition, discusses the need for a biopsy due to the pigmented lesion, and documents this in the patient’s medical record.

The dermatologist performs the nail unit biopsy, which involves the collection of tissue or cells from the nail unit for further examination and diagnosis.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11755, is used to bill for the service.

 

CPT CODE  – 11760 Repair of nail bed

 

CPT code 11760 is used to report the removal of nail bed lesions (such as tumors or cysts) by excision.

CPT code 11760 is used for the “Repair of Nail Bed.” This code is used when a healthcare provider performs a procedure to repair damage to the nail bed. Here

are some coding guidelines and an example of how to use CPT code 11760:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Repair of Nail Bed.” This CPT code should be used when the nail bed requires repair due to injuries, trauma, or other damage.

 

Medical Necessity: The repair should be medically necessary. Nail bed repair is typically performed when there is damage to the nail bed that requires intervention to promote proper healing, prevent complications, and restore nail function.

 

Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should indicate the reason for the repair, the specific nail bed involved, and the extent of the repair performed.

 

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

 

Example:

Let’s consider an example where a patient, Ms. Anderson, has sustained a deep laceration to the nail bed of her index finger due to an accident. The injury has damaged the nail bed, causing severe pain and the inability to use the finger properly.

Ms. Anderson seeks medical attention at an emergency room, and the healthcare provider assesses her condition, notes the medical necessity of repairing the nail bed due to the laceration and impaired function, and documents this in the patient’s medical record.

The healthcare provider performs the repair of the nail bed, which may involve suturing the wound, addressing any tissue damage, and ensuring that the nail bed is properly reconnected for optimal healing and function.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11760, is used to bill for the service.

 

 

CPT CODE -11762 Reconstruction of the nail bed with graft

 

CPT Code 11762 is used for “Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal.” This CPT code is used when a healthcare provider performs a procedure to partially or completely remove the nail and nail matrix with the intent of permanent removal. Here are some coding guidelines and an example of how to use CPT code 11762:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Excision of Nail and Nail Matrix, partial or complete.” This  CPT code should be used when the nail and nail matrix need to be partially or completely removed for permanent removal, typically due to chronic nail conditions, deformities, ingrown nails, or other persistent issues.

 

Medical Necessity: The procedure should be medically necessary. Excision of the nail and nail matrix is performed when conservative treatments have failed, and permanent removal is required to address a recurring issue or chronic condition.

Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should indicate the need for the excision, the specific nail involved, the extent of the procedure performed, and the reason for permanent removal.

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

 

Example:

 

Let’s consider an example where a patient, Mr. Williams, has been suffering from chronic ingrown toenails on both of his big toes. He has tried conservative treatments without success, and the condition is causing severe pain and recurrent infections.

Mr. Williams consults with a podiatrist who assesses his condition, discusses the medical necessity of permanently removing the ingrown nails, and documents this in the patient’s medical record.

The podiatrist performs the excision of the nail and nail matrix, partially or completely removing the affected portion of the nails and nail matrices on both big toes to prevent recurrence.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11762, is used to bill for the service.

 

CPT CODE -11765 Wedge excision of the skin of nail fold (eg, for ingrown toenail)

 

CPT code 11765 is used to report the repair of the nail matrix (the tissue from which the nail grows) or nail bed.

CPT code 11765 is used for “Wedge Excision of Skin.” This CPT code is typically used when a healthcare provider performs a procedure to excise a wedge-shaped piece of skin for various reasons, including the removal of lesions, biopsy, or other medical purposes. Here are some coding guidelines and an example of how to use CPT code 11765:

 

Coding Guidelines:

 

Correct Procedure: Ensure that the procedure being coded is indeed the “Wedge Excision of Skin.” This CPT code should be used when a wedge-shaped piece of skin is excised for a specific medical purpose.

 

Medical Necessity: The procedure should be medically necessary. Wedge excision of skin is typically performed to remove a skin lesion, conduct a biopsy, or address a medical condition that requires the removal of a wedge-shaped piece of skin.

 

Documentation: Proper documentation of the procedure is crucial for coding accuracy. The medical record should indicate the reason for the excision, the specific location on the body, and the extent of the excision performed.

 

CPT Modifiers: If there are specific circumstances that affect the procedure or the patient, modifiers may be added to the code for additional information or to indicate special circumstances.

Example:

Let’s consider an example where a patient, Mrs. Davis, has a suspicious skin lesion on her forearm. She visits a dermatologist for evaluation, and the dermatologist determines that a wedge excision is necessary for further evaluation and potential removal of the lesion.

The dermatologist assesses Mrs. Davis’s condition, discusses the medical necessity of the wedge excision to investigate the suspicious skin lesion, and documents this in the patient’s medical record.

The dermatologist performs the wedge excision of the skin lesion, which involves removing a wedge-shaped piece of skin, including the lesion, for biopsy and potential further treatment.

In the medical billing and coding process, the appropriate CPT code for the procedure, 11765, is used to bill for the service.

 

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