ED Coding and Reimbursement Alert

Question: Our ED physician treated a patient whose big toenail was almost completely torn off in an injury. The physician established a digital block, then removed the remaining nail that was hanging on, going down to, but not including, the matrix. Is 11750 the best code in this case? Should I code the block separately?

Illinois Subscriber

Answer: No, you shouldn’t code 11750 (Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal) in this case, even though the procedure note mentions the nail matrix. The 11750 procedure involves intentional destruction of the nail matrix for permanent removal of the nail, so that it won’t grow back, possibly in conditions such as ingrown nails. The 11750 procedure might involve steps such as phenol application or electrocautery to destroy the nail matrix.

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). In most cases, you would also be able to report an E/M service (99281- 99285), assuming the documentation justifies it.