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Podiatry Coding & Billing Alert

READER QUESTIONS:

Code Only Medically Necessary Nail Trims

Published on Sun Sep 20, 2009

Question: The doctor in our clinic trims almost every patient's nails upon consultation but only codes for this service occasionally. Is there any reason why we cannot code nail trimming every time the doctor performs this service? Louisiana Subscriber Answer: You cannot code for routine trimming of nails. CPT does not even include a code for this service since Medicare and most private payers do not consider this procedure medically necessary. You can bill for nail trimming, however, if it is an essential medical procedure. Some examples of diagnoses that support medical necessity for nail trimming include: • 110.1 -- Dematopytosis of nail • 681.10 -- Unspecified cellulitis and abscess of toe • 681.11 -- Onychia and paronchia of toe • 703.0 -- Ingrowing nail • 719.17 -- Difficulty in walking • 729.5 -- Pain in limb • 781.2 -- Abnormality of gait. Bonus: Payers may also consider nail trimming medically necessary for patients with diabetes mellitus [...]
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