Podiatry Coding & Billing Alert

Question: How do you handle coding for common nail conditions?

Answer: First, you should know the difference between nail trimming and nail debridement. Trimming of a nail is a procedure that is intended to reduce only the length of the nail. Your podiatrist can perform this service on a normal nail or a dystrophic nail. Meanwhile, debridement of a nail is a procedure that is intended to remove excessive material (e.g., to significantly reduce nail thickness/bulk) or excessive curvature from a clinically and significantly thickened dystrophic or diseased nail. It's also important you look at the LCD for individual regions for guidence with nail care.

Code it: You should use 11720 (Debridement of nail[s] by any method[s]; 1 to 5) when debriding a total of one to five nails and CPT 11721 (Debridement of nail[s] by any method[s]; 6 or more) for debriding greater more than six nails. Again, one may trim a dystrophic nail (G0127, Trimming of dystrophic nails, any number) or a non-dystrophic nail (CPT 11719 , Trimming of nondystrophic nails, any number).

The physician may also choose oral and topical antifungal treatment courses, which would be monitored in follow-up visits.

There are other options for treating fungal nails and tinea. It is perfectly acceptable to schedule follow-up visits to monitor the progress of oral and topical antifungal treatment courses. Considerations and evaluations of possible treatment protocol changes constitute an E/M service.

Tip: Payers do not reimburse debridement of nails as an adjunct to oral or topical therapy separately from E/M unless the patient meets "at-risk" or painful nail criteria. Make sure you check for regulations regarding the use of specific qualifying secondary diagnosis and Q modifiers that need to be listed on the claim form.