Podiatry Coding & Billing Alert

Question: Our podiatrist mechanically debrided and trimmed a patient’s dystrophic nails with nail nippers and then sent the nail unit for fungal culture and potassium hydroxide (KOH) prep for nail unit infection. They want to bill 11755 along with 87101 and 87220. Is this correct?

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Answer: CPT^® code 11755 (Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)) is often used, incorrectly, to send a nail clipping to pathology to confirm fungus (tinea unguium). However, the code is intended for cancer biopsies, and so should not be used in this case.

In this encounter, you should use 11720 (Debridement of nail(s) by any method(s); 1 to 5) for the debridement only.

As for the fungal culture, 87101 (Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail) and/or 87220 (Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)) would be appropriate, depending on circumstances and whether the cultures are performed in-house (i.e. performed within your practice in a lab owned and operated by you). If your podiatrist sends out for the labs, you cannot report these codes.