Podiatry Coding & Billing Alert

Question: Our podiatrist cuts nails and sends them out to the laboratory for a potassium hydroxide (KOH) study. Should I report the procedure as a biopsy or as a debridement?

New York Subscriber

Answer: You'll determine whether you should use a biopsy or debridement code by determining how much of the nail and/or tissue your podiatrist removes and sends for testing determines.

Option 1: You should use 11755 (Biopsy of nail unit [eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]) only if your podiatrist sends the nail unit, including folds, bed, and/or matrix, along with a section of the hard nail.

Tip: While a nail biopsy is a separate procedure, podiatrists usually perform the biopsy as part of a more complex service. If the physician performs a biopsy only, you can report 11755 on its own. If the podiatrist performs the biopsy along with an unrelated procedure, append modifier 59 (Distinct procedural service) to 11755.

Option 2: Use 11720 (Debridement of nail[s] by any method[s]; 1 to 5) or 11721 (... 6 or more nails) if your podiatrist removes dead or contaminated parts ofthe nail(s). You can only report this code if your podiatrist needs to send the cut nails or tissue to the laboratory for evaluation.

Option 3: If your podiatrist merely trimmed healthy nails, use 11719 (Trimming of nondystrophic nails, any number). There is no need to send the cut nails to the laboratory in this instance.

Report 11719 only once even if your podiatrist performs the procedure on more than one nail. Non- Medicare payers may also require you to report HCPCS Level II code S0390 (Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions [e.g. diabetes], per visit) along with 11719.

This is particularly true if you provided the service as routine foot care or as a preventive maintenance procedure for a particular medical condition.

Answer: You'll determine whether you should use a biopsy or debridement code by determining how much of the nail and/or tissue your podiatrist removes and sends for testing determines.

Option 1: You should use 11755 (Biopsy of nail unit [eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]) only if your podiatrist sends the nail unit, including folds, bed, and/or matrix, along with a section of the hard nail.

Tip: While a nail biopsy is a separate procedure, podiatrists usually perform the biopsy as part of a more complex service. If the physician performs a biopsy only, you can report 11755 on its own. If the podiatrist performs the biopsy along with an unrelated procedure, append modifier 59 (Distinct procedural service) to 11755.

Option 2: Use 11720 (Debridement of nail[s] by any method[s]; 1 to 5) or 11721 (... 6 or more nails) if your podiatrist removes dead or contaminated parts of the nail(s). You can only report this code if your podiatrist needs to send the cut nails or tissue to the laboratory for evaluation.

Option 3: If your podiatrist merely trimmed healthy nails, use 11719 (Trimming of nondystrophic nails, any number). There is no need to send the cut nails to the laboratory in this instance.

Report 11719 only once even if your podiatrist performs the procedure on more than one nail. Non-Medicare payers may also require you to report HCPCS Level II code S0390 (Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions [e.g. diabetes], per visit) along with 11719.

This is particularly true if you provided the service as routine foot care or as a preventive maintenance procedure for a particular medical condition.