Orthopedic Coding Alert

Question: Our foot surgeon performed a toenail excision and nail bed repair with a digital block. Can we report both the nail excision and the digital block? 

Kansas Subscriber

Answer: The repair of nail bed and tuft fracture are procedures that foot surgeons frequently perform because of trauma, such as a crush injury of the foot. 

For the toenail excision, you should report 11750 (Excision of nail and nail matrix, partial or complete [e.g., ingrown or deformed nail] for permanent removal). This code involves removal of all or part of a fingernail or toenail, including the nail plate and matrix.

If the surgeon removes the entire tuft of the distal phalanx, you should report 11752 (... with amputation of tuft of distal phalanx) instead.

If the physician enlarges and removes all or part of a nail, you can report 11730 (Avulsion of nail plate, partial or complete, simple; single). For this procedure, the surgeon bluntly dissects the nail plate from the nail bed. He may close small wounds with simple repair. If the wound requires immediate reconstruction with local flaps, you can report these separately. 

Physicians may use digital blocks to numb the top of the digit, but you should not separately report 64450 (Injection, anesthetic agent; other peripheral nerve or branch) for the digital block, because this procedure is included in the surgery based on CPT®’s definition of a “surgical package.”

In addition, the National Correct Coding Initiative (CCI) bundles 64450 into 11750, 11752 and 11730.

As is the case with all surgical codes, you must report a significant procedure. If the nail is hanging by a thread and the orthopedic surgeon simply snipped it off (no digital block required), do not report 11730. As always, documentation must support any services performed.