Podiatry Coding & Billing Alert

Hint: Code 11750 can be performed using surgical, laser, electrocautery, or chemical techniques.

Ingrown toenail surgeries are a procedure you will most likely encounter during your podiatry coding career. In fact, according to Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina, ingrown toenail procedures are so common that he performs at least five a day in his practice.

Test yourself with the following scenario to bolster your ingrown toenail surgery reporting skills.

Scenario:

An established patient came into the podiatrist’s office to follow-up with lateral left foot pain she sustained two weeks ago when she rolled her foot while walking down the stairs. The patient is wearing the CAM boot she received in the office on her last visit. She is still experiencing pain on the top of her foot. After a medically appropriate obtaining history and examining her foot, the podiatrist concluded that she could continue wearing the CAM boot so her foot can heal. The podiatrist used low level medical decision making (MDM) during this exam.

While she was here, the patient mentioned that she also has right great toenail pain on the medial and lateral sides. The patient said has had problems off and on with this toenail for the past few weeks, and the pain has become unbearable. Footwear, standing, and walking all aggravate the nail. After reviewing the nature of the problem and conservative treatment options such as vinegar soaks, creams, and medical pedicures with the patient, she elected for a permanent chemical matrixectomy of the offending nail border. The podiatrist reviewed the procedure and post-up follow up with that patient, and she was agreeable.

During the chemical matrixectomy, the podiatrist prepped the right great toe with alcohol and infiltrated a total of 3c of 1 percent lidocaine into the base of the toe. After noting successful induction of the anesthesia, the podiatrist used a torniquet for local hemostasis. The podiatrist then used an English Nail Splitter to excise the medial nail border to the eponychium. The podiatrist then performed one application of 89 percent phenol on a cotton topped applicator for one minute and flushed the area with vinegar solution. The podiatrist removed the tourniquet and noted normal digital vascular return. The podiatrist then dressed the site with Amerigel® ointment and a gauze dressing secured with tubigauze. The patient tolerated the anesthesia and procedure well and left ambulating comfortably. She was given oral and written instructions on post-op care. The podiatrist also prescribed Bactrim DS 800-160 mg oral antibiotics to prevent infection.

Step 1: Rely on These ICD-10 Codes

For the ICD-10-CM codes related to the injury the patient sustained when she rolled her foot, you should report M25.572 (Pain in left ankle and joints of left foot) and M77.52 (Other enthesopathy of left foot and ankle).

For the ICD-10-CM codes linked to the ingrown toenail pain, you can look to L60.3 (Nail dystrophy) and L60.0 (Ingrowing nail).

Step 2: Focus on CPT^® Choices

For the chemical matrixectomy, which is the excision of the nail matrix, you should report code 11750 (Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal) with modifier T5 (Right foot, great toe) appended.

Don’t miss: “Generally performed for severely deformed or ingrown nails, this procedure [11750] may be performed using surgical, laser, electrocautery, or chemical techniques,” according to CPT^® Assistant Vol. 12, No. 12.

E/M code: You can also report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) for the evaluation and management (E/M) visit. You should append Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same say of the procedure or other service) to code 99213 to show that it was a separately identifiable service for a follow-up to the left foot pain apart from the ingrown toenail surgery.

Caution: Keep in mind that some insurance companies will automatically deny an E/M with a procedure, and you can appeal these denials with documentation that the 99213 was not for the ingrown nail complaint. Modifier 25 is justifiable because one service has nothing to do with the other, and the podiatrist performed multiple services.

Step 3: Put It All Together on Your Claim

In summary, for this encounter, you would report the following codes on your claim:

• 11750-T5 for the matrixectomy linked to ICD-10-CM codes L60.0 and L60.3
• 99213-25 for the E/M service linked to ICD-10-CM codes M25.572 and M77.52