ED Coding and Reimbursement Alert

Question: A patient reports to the ED with blood and pus under his left third and fourth digit toenails. The physician performs simple avulsion on each toe, and uses cautery to control bleeding. Notes indicate a level-two E/M service. Can I code the trephination separately for each nail?

Pennsylvania Subscriber

Answer: You cannot code trephination for either repair, though you will be able to submit a CPT code for each avulsion. On the claim, report the following:

• 11730 (Avulsion of nail plate, partial or complete, simple; single) for the first avulsion
• +11732 (... each additional nail plate [List separately in addition to code for primary procedure]) for the second avulsion
• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) for the E/M service
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/M and the avulsions were separate services.

Explanation: The physician removed the nail, which means he did not perform trephination (11740, Evacuation of subungual hematoma); he removed the nail instead.