Primary Care Coding Alert

Question: I am confused as to when to code for avulsion of a toenail and when to code for an excision. What is the difference between the two procedures, and which codes should I use?

Louisiana Subscriber

Answer: The big difference between avulsion and excision lies in the last part of the CPT description for excision (11750): "Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal" (emphasis added). The nail matrix is the tissue at the base of the nail from which all nail growth originates. The confusion occurs because most FPs do not technically excise the matrix. Even though it is called a matrixectomy (-ectomy means "removal" or "take out"), most texts will describe more of a destruction, usually with a chemical called phenol, which kills the growth cells, preventing a new nail from forming. Podiatrists sometimes do a true excision, which requires suture closure.

Avulsion (11730*, Avulsion of nail plate, partial or complete, simple; single) is removing the existing nail or partial nail. Because the nail plate, or matrix, is left untouched, the nail should regrow. Avulsion is a starred procedure with no global period. However, because there is a higher rate of infection with destruction of the matrix (11750), it has a 10-day global period and post-op visits to ensure no complications are included.

Answered by Shannon Joyce, MD, clinical faculty at St. Vincent Family Medicine Residency in Indianapolis.