# Need help with toenail coding fast!



## pdunteman (Sep 22, 2009)

Podiatrist
Patient with infected toenail

"Plan:  At this time, it was determined that the patient would receive a SLANT BACK PROCEDURE because he is too young to have a partial nail avulsion at this time and would benefit the most from the slant back procedure to relieve the pressure from the soft tissue on the medial nail border.

This was conducted with a nail nipper without incident.  It was brought to pinpoint bleeding.  There was no pus or exudate around the regiion.  It was cleaned with an alcohol wipe and antibiotic ointment wass placed with dry, sterile dressings applied."

I cannot find any reference to the slant back procedure anywhere, but it seems to me that this is just a Trimming of nondystrophic nail?  Wouldn't this be a 11719?

Anyone have any thoughts?


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## hthompson (Sep 22, 2009)

If it was enough of a procedure that you think it's medically necessary to use a CPT code, then I think 11719 is as close as it gets.  I don't see any other codes that would be better.  If you aren't comfortable just coding the E/M, then I concur.

Quote from the internet: "the ACFAS guideline the slant back would not be considered a partial nail avulsion as per my post above, and therefore would fall under the category of "palliative" care. If you read the true guidelines for Medicare in PA (HGSA), in order to bill for 11730 anesthesia must be used and a simple slant back is not considered an avulsion. The nail must be taken below the eponychium."


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## Lisa Bledsoe (Sep 23, 2009)

I would only code the E/M since a true nail avulsion was not performed and the procedure was not as simple as trimming the nail.  On could argue to use 11719 -22 but:  1- you don't have an appropriate dx; and 2- what is the true increased service?.  You could also argue 11730-52 but again:  1- you don't have an appropriate dx; and 2 - insurance is likely to reduce significantly.  I think your best bet is to code an appropriate E/M.  Just my opinion.


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## pdunteman (Sep 23, 2009)

Thank you Heidi!

I appreciate your help with this!

Peg


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## pdunteman (Sep 23, 2009)

Thank you Lisa!

I appreciate your help!

Peg


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