ED Coding and Reimbursement Alert

Question: I would like to know which CPT code to use for removal of an ingrown nail, either partial or complete. I've been comparing 11750 (Excision of nail and nail matrix, partial or complete, [e.g., ingrown or deformed nail] for permanent removal) to 11730* (Avulsion of nail plate, partial or complete, simple; single). It's the "for permanent removal" reference in the code description that makes me question if 11750 is the correct code for most removals of ingrown toenails in the ED. In my experience, usually only the part of the nail that is ingrowing is cut away, and the nail will usually grow back. It would seem that for permanent removal, the germinal matrix would need to be removed. I think 11730 seems to be more appropriate when the nail is cut away, either partially or completely, and the germinal matrix is not removed. Is my reasoning correct? Wyoming Subscriber Answer: Ingrown toenails are approached two ways in the ER. A quick and dirty excision of the lateral nail fold limited to the "ingrown part" would be coded with 11765 (Wedge excision of skin or nail fold [e.g., for ingrown toenail]). A complete resection of the nail that was carried all the way back to include the lunula (white part at the base of the nail) and specifically mentions destruction of the germinal matrix would qualify for 11750. Code 11750 defines a partial or complete excision of nail and nail matrix for permanent removal. If permanent removal is the goal of the procedure you are describing, there are three ways to permanently remove the nail and insure no regrowth occurs: Complete excision of the matrix in its entirety, use of phenol, or use of silver nitrate. If the procedure note describes an aggressive resection, which includes the entire nail matrix, 11750 is likely satisfied. If a wedge excision has been performed, 11765 would be appropriate. 11730 is for removal of the nail plate and does not include the germinal matrix. This would be a common code for a blunt injury to the toe where the nail plate is partially avulsed and the clinician completes the process either for patient comfort or to repair the nail bed (11760, Repair of nail bed).