ED Coding and Reimbursement Alert

Question: A patient presented with a big toenail that was torn almost completely away from the toe in an injury. The physician performed a digital block and removed the entire nail to the matrix. Would this be considered a simple, complete removal or a 11750 service, and should we bill separately for the block?

Codify Subscriber

Answer: What you describe is a complete, simple nail removal, so you should report the service as 11730 (Avulsion of nail plate, partial or complete, simple; single).

Despite the fact that the procedure note mentions removal to the nail matrix, you should not use 11750 (Excision of nail and nail matrix, partial or complete [eg, ingrown or deformed nail], for permanent removal). The 11750 procedure involves intentional destruction of the nail matrix for permanent removal of the nail, so that it won’t grow back. That might involve procedures such as phenol application or electrocautery to destroy the nail matrix.

Tip: The 11730 nail-removal procedure includes the nerve block, so you should not report a separate code for the anesthesia.