Podiatry Coding & Billing Alert

Question: A 60-year old patient presented to emergency with a history of a heavy tile falling on his right foot. She has sustained avulsions of the bases of the nails of the great and second toes, which involve both the skin and nail beds of each toe. The podiatrist provides local anesthesia and removes the entirety of each nail, sutures a 1 cm laceration of the skin of each toe and also sutures 1.5 cm lacerations of the nail beds of each toe. He documents nail bed repair of great toe with 4 sutures of 6.0 Vicryl and repair of nail bed of second toe with 3 sutures of 6.0 Vicryl, and mentions that he completely removed (or avulsed) the damaged nails from these two toes and also fails to mention that he repaired 1 cm lacerations of the skin adjacent to each nail with 2 sutures of 4.0 nylon. He also ordered an x-ray. We had not seen the patient until she was referred to us for consultation. What codes should I use to report these procedures?

South Carolina Subscriber

Answer: First, you have to bill the nail bed repair as 11760 (Repair of nail bed) and report it as "2 units" to indicate that two nail beds were repaired.

Note: CPT 11760 bundles the removal of the nail into the payment for the "repair of nail bed". Then, report two units of 12001 (Simple repair of wounds of skin [2.5 cms or less]) so the pay for a single unit is doubled. For the x-ray, you should submit 73630 (X-ray exam of foot), but remember that you can bill an x-ray only if it was taken in your office. Don't forget to report the visit using an E/M code.