These 2 codes cannot be billed together for the same nail. 11750 is a more intensive version of 11730. 11730 is performed so the nail can grow back. 11750 in addition to remove of the nail, the matrix/nailbed is killed off so the nail doesn't grow back. The descriptions for CPT codes 11730, 11732 and 11750 indicate partial or complete.
Can CPT code 11730 and 11750 be billed together?
These 2 codes cannot be billed together for the same nail. 11750 is a more intensive version of 11730. 11730 is performed so the nail can grow back. 11750 in addition to remove of the nail, the matrix/nailbed is killed off so the nail doesn't grow back. The descriptions for CPT codes 11730, 11732 and 11750 indicate partial or complete.
Is 11730 a misprint in Codex?
I showed him in CodeX that 11730 is included with 11750. He, however, disagrees because the GSD lists 11730 as exposure/excision of nail bed/matrix. He states he performed an avulsion so he feels this is a misprint in CodeX and he can bill these procedures separately on that DOS. Input please?
What does code 11730 mean on nails?
When one of these codes is reported, it represents all services performed on that nail for that date of service. When borders of a nail are involved, do not report a separate code for each border and do not report an avulsion (11730) and an excision (11750) for the same nail.
How do you code toenail removal 11750?
Excision: You should code each toenail removal. Report 11750 for the first complete removal and 11750 for the second removal. You correctly append modifier -50 (Bilateral procedure) to the second 11750 (Excision of nail and nail matrix partial or complete [e.g. ingrown or deformed nail] for permanent removal).
What modifier should be used with 11730?
-The nail avulsion (CPT 11730) should be billed as the first procedure with L60. 0 as the primary diagnosis and L03. 032 as the secondary diagnosis, and the -TA modifier as primary.
Does CPT code 11730 need a modifier?
When billing for non-covered services, use the appropriate modifier. The description of CPT codes 11730, 11732 and 11750 indicates partial or complete avulsion or excision of a nail plate. When CPT code 11730, 11732 or 11750 is reported, it represents all services performed on that nail for that date of service (DOS).
What is included in CPT 11750?
11750: Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; Lay Description: The physician removes all or part of a fingernail or toenail, including the nail plate and matrix permanently.
What modifier is used for 11750?
Modifier 25 indicates that a SIGNIFICANT, separately identifiable E&M service (ie. CPT 99202) was performed during the same encounter that a minor surgical procedure (ie. CPT 11750) was performed.
What is the difference between CPT code 11730 and 11750?
11750 is a more intensive version of 11730. 11730 is performed so the nail can grow back. 11750 in addition to remove of the nail, the matrix/nailbed is killed off so the nail doesn't grow back. The descriptions for CPT codes 11730, 11732 and 11750 indicate partial or complete.
How often can 11730 be billed?
Medicare will allow ten services per beneficiary per 24 months for CPT codes 11730 and/or 11732. Payment for services beyond this number will require medical review of patient records to determine medical necessity.
Does CPT 11750 have a global period?
Per CMS, CPT code 11750 has a global period of ten days; which means the fee associated with the procedure takes into account the post-op care. It is highly recommended that patients be seen during this time as they are entitled to the post-op encounter.
Does CPT code 11730 have a global period?
As per CMS, there is no global period for CPT 11730. A follow-up visit can be scheduled for a patient after the minor procedure that will not be considered inclusive to the payment for the nail avulsion.
How Much Does Medicare pay for 11730?
When damage to the nail is extensive and removal is required, report it with CPT code 11730 (avulsion of nail plate, partial or complete, simple, single, 1.58 RVUs, Medicare $56.94).
Can you use two modifiers on one CPT code?
CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.
What is the difference between avulsion and Excision of nail?
Avulsion of a nail involves separation and removal of the entire nail plate or a portion of nail plate and an excision of the nail and the nail matrix is generally performed under local anesthesia requiring separation and removal of the entire nail plate or a portion of nail plate and is a permanent removal.
How do you code excision of multiple lipomas?
If the lipoma were located superficially, the removal of the lipoma would be coded to excision of a benign lesion. The appropriate code would fall into the CPT code range 11400-11446 based on location and size of the lipoma removed.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Refer to the Novitas Local Coverage Determination (LCD) L34887, Surgical Treatment of Nails, for reasonable and necessary requirements. The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code (s) may be subject to National Correct Coding Initiative (NCCI) edits.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the "ICD-10Codes that Are Covered” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
