ED Coding and Reimbursement Alert

Question: What codes would your assign for the following chart note:

Wound Repair of 1cm (0.4 in) involving nail bed laceration to dorsal aspect of distal phalanx of left middle finger. Irregularly shaped. Skin/tissue flap noted. Distal neuro/vascular/tendon intact. Anesthesia: Digital block administered with 4 mls of 1% lidocaine. Wound prep: Moderate cleansing with Betadine, Wound explored moderately, Copious irrigation. Subungal hematoma is drained. Nail avulsed fully and removed. Closed with 8 5-0 chromic and nail bed repaired, nail reattached and tacked down with 2) 5-0 vicryl sutures. Dressed with Bacitracin, tube gauze.

Answer: The question to answer in coding this case is determining whether it is a nail bed repair or a laceration repair and which discrete services may be reported. CPT® Assistant has provided the following description of a nail bed repair as opposed to a laceration repair of the area.

"For lacerations to the nail bed, a portion or all of the nail plate is removed in order to visualize the laceration. The laceration of the nail bed is repaired meticulously with sutures. When the nail bed wound extends under the proximal nail fold, bilateral incisions may be made on either side of the proximal nail fold to access the wound. The nail fold is raised, and the nail bed wound is repaired with sutures."

Code the scenario above as a nail repair using 11760 (Repair of nail bed).

Other codes you might have considered are typically bundled into the nail bed repair code:

• 11730 (Avulsion of nail plate, partial or complete, simple; single) has a CCI edit with 11760 and in this case can't be reported.
• 11740 (Evacuation of subungual hematoma) also has a CCI edit in place with 11760 and can't be separately reported

Keep in mind the 12000 laceration repair codes also have CCI edits and are bundled into the nail bed repair.

The digital block 64450 (Injection, anesthetic agent; other peripheral nerve or branch) is bundled both by CCI edits for 11760 and according to the CPT surgical package instructions.

Payment for 11760 is $ 130.13 on 3.83 totals RVUs.