Pediatric Coding Alert

Question: A child who slammed his finger in the garage door came in with an injured hand and avulsion of the fingernail. The service's documentation states trimming of the avulsed nail. The pediatrician did not give a digital nerve block or provide routine foot care. Should I still use 11719 or 11730? Or should I include the work in the E/M code?

Illinois Subscriber

Answer: Go with 11719 (Trimming of nondystrophic nails, any number). You may associate 11719 coverage with Medicare's non-routine foot care criteria. But you can use the CPT code for trimming of a nail that doesn't have dystrophic changes, which are typically progressive and may result from defective nutrition of a tissue or organ. The nail in your scenario is injured and not dystrophic. Code 11719 nationally pays approximately $19 (0.53 total relative value units) using the 2009 Medicare Physician Fee Schedule.

You should not code for performing the avulsion because the patient came in with the nail fold already partially separated from the nail plate. Reserve 11730 (Avulsion of nail plate, partial or complete, simple; single) for when your physician separates the patient's nail fold from the underlying nail plate. The 2009 Medicare Physician Fee Schedule assigns this painful procedure 2.47 relative value units (RVUs), which equals approximately $89 nationally.

For the evaluation of the injured hand and the evaluation of the nail that is above and beyond the minor E/M associated with 11719, you could still code the appropriate level E/M service appended with modifier 25.