Wiki Skin Biopsy vs Nail Biopsy

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tholcomb

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Good afternoon fellow Coders,

I have a doctor who wants to bill cpt code 11100 skin biospy for a toe nail clipping to confirm a diagnosis see below my question is should I use cpt code 11755 instead?

Site A: right big toe
Procedure Other
Margins: No
Diagnosis Comments: pas stain

Site A
Pathological Diagnosis: Hyperkeratotic Nail Fragment, see comments
Comments: The Periodic Acid-Schiff stain is negative for fungi.
Gross Description: Received in 10% formalin is a nail clipping. The nail is submitted in toto in one cassette.


Thank you,
TH
 
Actually, neither.

11100 is for skin, and re: 17555...

CPT code 11755, Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure), is not intended to be reported when obtaining nail clippings or nail bed scrapings for purposes of performing a fungal culture, KOH preparation, stain or test, or PAS stain. These activities are part of an evaluation and management visit involving the medical management of the nail condition. When medically appropriate, nail trimming and/or nail debridement services should be indicated with the specific
codes.

Source: AMA CPT Assistant Q&A - October 2004 CPT Assistant Newsletter

I work clinically in dermatology (PA) and I will admit that there was confusion at first. Even despite the above AMA position, some docs will still argue the point. However, at the end of the day, it's literally clipping someone's nail with clippers and just takes a few seconds to perform. There is cost, of course, in sterilizing the clippers, time spent on filling out the path forms, etc., but most will now perform it at no extra charge beyond the visit (since no "reasonable" CPT code exists for the service).

Tim
 
I'd like to bring this thread up-to-date.. Does anyone know of any recent sources that support or contradict that 2004 CPT Assistant Q&A response?
 
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