Podiatry Coding & Billing Alert

Question: Our podiatrist completely removed a patient’s toenail and evacuated a subungual hematoma. After injecting lidocaine into the paronychia around the nail, the podiatrist made an incision to drain a large amount of blood, then injected lidocaine into the right second toe base for a digital nerve block. The podiatrist then completely removed the toenail using forceps.

Do I use 11730 and 11740 or do I use 11740 and 11750 for this?

AAPC Forum Participant 

Answer: In this situation, using 11750 (Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal) would not be correct, as the notes you provide do not discuss the intentional destruction of the nail matrix for permanent removal of the nail so that it won’t grow back. Procedures described by 11750 usually involve phenol application or electrocautery to destroy the nail matrix, neither of which you describe.

This means 11730 (Avulsion of nail plate, partial or complete, simple; single) would be a better description of the procedure. This procedure, which leaves the nail matrix intact, includes the nerve block, so you should not report a separate code for that. Also, as the podiatrist performed the procedure on the second toe of the right foot, you should add modifier T6 (Right foot, second digit) to the toenail removal code to indicate which toenail the provider removed.

As for the evacuation of the subungual hematoma, 11740 (Evacuation of subungual hematoma) would be correct.

And don’t forget: If this was not a planned removal, and the visit was the patient’s initial one for the condition, you should be able to add an appropriate office/outpatient evaluation and management (E/M) from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …), adding modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M to show that the service to evaluate and manage the patient’s condition was separate and significant.

This means your final coding for the encounter, assuming a low level of medical decision making (MDM) for the E/M, would look like this:

• 99203/99213-25
• 11730-T6
• 11740.