astaud
New
Hi everyone,
I've been coding podiatry for 3 years and remain confused about the difference in the language between these two procedures. I have watched YouTube videos from 5 different channels demonstrating these procedures--though some of the videos labeled as "nail avulsions" use phenol at the end of the procedure, and I thought phenol was only used a chemical agent to DESTROY the matrix--So now I'm wondering if phenol is routinely applied during nail avulsion procedures not to permanently destroy, but rather to discourage the nail from growing? I have no idea. I'm just so confused. Additionally, the components of both procedures sound very similar. I even broke down the descriptions from my Coding companion book into simpler language and it still did not help me. Here is my condensed description (taken from the Optum Coding Companion AND vitalware):
Nail avulsion (11730): The physician bluntly dissects the nail plate from the nail bed
A freer elevator is inserted under edge of the nail plate and lifted
A gap forms between the nail bed and the nail plate
The freer elevator is moved in a side to side motion to free up the lateral margins of the nail
The freer elevator is then inserted under the cuticle and again moved in a side to side motion
A hemostat is used to grasp the nail
The nail is avulsed with twisting motion
Matrixectomy (11750): the physician removes all or part of the nail plate and destroys the matrix permanently
A freer elevator is inserted under the distal edge of the nail and is used to
free up the nail plate from lateral edge
The new lateral edge is identified
A nail splitter is used to cut the nail straight back to the most proximal edge under the nail fold
A hemostat is used to grasp the severed lateral piece of nail
The nail is pulled straight out toward the end of the toe
The nail matrix is destroyed with application of Phenol
So, the first 3 steps sound very similar to me up until the freer elevator starts freeing, haha. Are the lateral margins of the nail the same as the lateral edge of the nail plate? I'm Having a very difficult time picturing this...maybe that's why I'm struggling. Only other main difference I noticed is that phenol is not used in 11730, but it is in 11750, to destroy (but again, this is contrary to what I have been watching online)
****Here is a procedure note from a chart I am trying to code*****
"Attention was directed to the lateral border of the right hallux. After anesthesia was established, hallux was swabbed with betadine to provide aseptic environment. One rubber glove was utilized as tourniquet for hemostasis. Spatula was utilized to free up hyponychium, epionychium and lateral border. At this point, an english anvil was advanced along the nail 4 mm from affected nail border clipping nail down to root of nail. Hemostat was used to remove nail and curette used to determine if spicules present. Phenol was applied to lateral hallux nail bed for 3 applications 30 seconds apiece. Hallux flushed with copious amounts of rubbing alcohol, betadine was applied to surgical site and covered with gauze and coban."
It sounds like he's using an English anvil instead of nail splitter, to cut the nail straight back to the root of the nail aka "the most proximal edge", and phenol was used, so would 11750 be appropriate??
Thanks for any help!!
I've been coding podiatry for 3 years and remain confused about the difference in the language between these two procedures. I have watched YouTube videos from 5 different channels demonstrating these procedures--though some of the videos labeled as "nail avulsions" use phenol at the end of the procedure, and I thought phenol was only used a chemical agent to DESTROY the matrix--So now I'm wondering if phenol is routinely applied during nail avulsion procedures not to permanently destroy, but rather to discourage the nail from growing? I have no idea. I'm just so confused. Additionally, the components of both procedures sound very similar. I even broke down the descriptions from my Coding companion book into simpler language and it still did not help me. Here is my condensed description (taken from the Optum Coding Companion AND vitalware):
Nail avulsion (11730): The physician bluntly dissects the nail plate from the nail bed
A freer elevator is inserted under edge of the nail plate and lifted
A gap forms between the nail bed and the nail plate
The freer elevator is moved in a side to side motion to free up the lateral margins of the nail
The freer elevator is then inserted under the cuticle and again moved in a side to side motion
A hemostat is used to grasp the nail
The nail is avulsed with twisting motion
Matrixectomy (11750): the physician removes all or part of the nail plate and destroys the matrix permanently
A freer elevator is inserted under the distal edge of the nail and is used to
free up the nail plate from lateral edge
The new lateral edge is identified
A nail splitter is used to cut the nail straight back to the most proximal edge under the nail fold
A hemostat is used to grasp the severed lateral piece of nail
The nail is pulled straight out toward the end of the toe
The nail matrix is destroyed with application of Phenol
So, the first 3 steps sound very similar to me up until the freer elevator starts freeing, haha. Are the lateral margins of the nail the same as the lateral edge of the nail plate? I'm Having a very difficult time picturing this...maybe that's why I'm struggling. Only other main difference I noticed is that phenol is not used in 11730, but it is in 11750, to destroy (but again, this is contrary to what I have been watching online)
****Here is a procedure note from a chart I am trying to code*****
"Attention was directed to the lateral border of the right hallux. After anesthesia was established, hallux was swabbed with betadine to provide aseptic environment. One rubber glove was utilized as tourniquet for hemostasis. Spatula was utilized to free up hyponychium, epionychium and lateral border. At this point, an english anvil was advanced along the nail 4 mm from affected nail border clipping nail down to root of nail. Hemostat was used to remove nail and curette used to determine if spicules present. Phenol was applied to lateral hallux nail bed for 3 applications 30 seconds apiece. Hallux flushed with copious amounts of rubbing alcohol, betadine was applied to surgical site and covered with gauze and coban."
It sounds like he's using an English anvil instead of nail splitter, to cut the nail straight back to the root of the nail aka "the most proximal edge", and phenol was used, so would 11750 be appropriate??
Thanks for any help!!