Primary Care Coding Alert

Question: A Medicare patient presents with a painful ingrown toenail. The FP trims the nail. What code should I use? Also, since the patient doesn't have a systemic condition, will Medicare cover the procedure?

Utah Subscriber
 
Answer: For the nail trimming, you should report 11719 (Trimming of nondystrophic nails, any number) or G0127 (Trimming of dystrophic nails, any number). Choose the code based on whether the nail is nondystrophic or dystrophic.
 
Normally, Medicare considers nail trimming as routine foot care and a noncovered service absent a systemic condition and qualifying findings. But Utah's Part B carrier, Regence Blue Cross Blue Shield, will pay for trimming an ingrown nail (703.0, Ingrowing nail; 681.11, Onychia and paronychia of toe; or 686.9, Unspecified local infection of skin and subcutaneous tissue).