General Surgery Coding Alert

Question: Our surgeon treated a patient in the office whose big toenail was almost completely torn off in an injury. The surgeon established a digital block, then removed the entire nail to the matrix. Is 11750 the best code in this case due to removal to the matrix? 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 documents removal to 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).

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