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Tips For Nail Coding :Increase Reimbursement

Image result for wedge excision of nail fold

Focus On Common Procedure Of Nail

Trimming of nondystrophic and dystrophic nails

Cutting and shaping of nondystrophic nail (a normal nail) and dystrophic nail ( poor nail formation, usually as the result of trauma or infection. When caused by trauma, the nail becomes discoloured due to blood pooling underneath the nail. Over time, the nail breaks away from the nail bed until it detaches completely.)

161 CODING TIP:-

For proper coding of trimming procedure, First we should check the document like is it dysotrophic or nondysotrophic nail and can be coded as:

  • G0127 : Trimming of dystrophic nails, any number
  • 11719 : Trimming of nondystrophic nails, any number

Note: Apply either code appropriately for one or more nails

Debridement of nail

The cleaning and removal of all infected nail to the nail bed or viable nail plate or to the point where bleeding is running. Simply trimming is not considered as debridement.

161 CODING TIP:-

Nail debridement is depend upon the number of nail

  • 11720 : Debridement of nail(s) by any method(s); 1 to 5
  • 11721 : Debridement of nail(s) by any method(s); 6 or more.

Avulsion of nail plate

Nail avulsion is the separation of the nail plate from the surrounding structures and are most frequently performed surgical or nonsurgical, chemical procedure on the nail unit.

161 CODING TIP:-

Nail avulsion can be done partial or complete and also depend on number of nail plate :

  •   11730 : Avulsion of nail plate, partial or complete, simple; single for the first procedure.
  • +11732 : Avulsion of nail plate, partial or complete, simple; each additional nail
    plate (Add seperately)

Example: if the physician performed four avulsions, report 11730,11732 x 3.

Evacuation of Nail

Removal of infected nail or hematoma is known as Evacuation.

161 CODING TIP:-

Subungual hematoma can evacuated by giving local anaesthesia and can be coded as:

11740 : Evacuation of subungual hematoma

Excision of nail and matrix

Partial, complete or permanent removal of ingrown nail and infected matrix is an excision procedure.

161 CODING TIP:-

Excision of nail occur with amputation or without amputation. So supporting documents read carefully.

  • 11750 : Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;
  • 11752 :  Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; with amputation of tuft of distal phalanx

Biopsy of nail unit

Nail biopsy is a surgical procedure in which a tissue specimen is obtained
from the growth plate of a fingernail or toenail. Biopsy of nail unit is to determine the pathogenicity of fungal organisms or fungal infection for the identification and treatment of pain (eg, ingrown nails, tumors).

161 CODING TIP:-

Biopsy of nail unit can be coded as:

11755 : Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds)

NOTE:- When biopsy of the nail bed is performed after avulsion of the nail plate, then never can be coded seperately because biopsy is included in avulsion.

Repair and reconstruction of Nail bed

Reconstruction of the dorsal roof of the eponychium helps restore the normal ability to the regenerating the infected or fragile nail.

161 CODING TIP:-

Repair codes of nail bed is depend on the procedure done with or without graft.

  •  11760 : Repair of nail bed.
  •  11762 : Reconstruction of nail bed with graft.

NOTE :- The details of reconstruction will depend on the nature and extent of the defect. Generally, a split thickness graft is used from the nail and sometimes full thickness grafts may be used.

Wedge excision of Nail fold skin

Wedge resection is a surgical procedure to remove a triangle-shaped slice of tissue from the nail matrix. It may be used to remove a tumor or some other type of tissue that requires removal and typically includes a small amount of normal tissue around it

161 CODING TIP:-

Wedge excision of the nail fold skin is performed typically to remove hypertrophic lateral nail folds that result from chronic ingrown toenails. can be coded as:

11765 : Wedge excision of skin of nail fold

aaaaa E/M Services

If all above procedures may be performed in same e/m visit- Use modifier 25 for separate billing.

 

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51 thoughts on “Tips For Nail Coding :Increase Reimbursement”

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