Can You Code For Replacement Of Nail And Eponychial Fold After Nail Bed Repair?

Long-lasting Tips for Superior Nail Coding

Pay attention to v details when filing claims.

Past Sivaraj Ramesh, CPC, CEMC, CCS
To file authentic claims when coding and billing nail procedures, be familiar with the nuances of nail anatomy, common weather condition, treatments, services, and procedures. Hither are some tips to point you towards better nail reporting.

Tip i: Nail Down Your Anatomy

Nails are thin, horny coverings that grow over the upper tip of a finger or toe. They are composed mainly of keratin (a difficult protein) and provide protection and awareness. The basic parts of the nail include:

Boom plate
Boom bed
Nail matrix
Nail walls
Blast grooves
Lunula
Cuticle
Mantle
Hyponychium
Free edge

Tip 2: Know What Ails Your Nails

Common causes of fingernail or toenail changes include trauma, crumbling, infection, skin diseases, and severe malnutrition. Common diseases of nails include the following:

Erythronychia: Red streaks in the boom that may present equally a single or paired band in ane blast, or every bit multiple bands in multiple nails.
Koilonychia: Also called spoon nail considering the outer surface of the smash becomes concave, resembling a spoon. May be associated with atomic number 26 deficiency anemia.
Melanonychia: Brown or black discoloration of the nail.
Onychia/Onychitis: Infection of soft tissue surrounding the nail, leading to inflammation and loss of smash.
Onychocryptosis: A mutual nail disease also known as an ingrown toenail, or unguis incarnates, in which the growing blast cuts either one or both the sides of the boom bed, causing pain, inflammation, and possible infection. May exist caused due to pressure from a tight fitting shoe or improper cutting of toenails.
Onychodystrophy: Dystrophic changes of the finger or toe nail such equally change in boom texture or composition, discoloration, or malformation. May exist congenital or acquired due to disease, injury, or infection.
Onychogryphosis: Overgrowth resulting in long, curved nails that resemble claws. The nails get thick and deformed, with discoloration. Occurs due to tight shoes, infection, trauma, decreased blood supply, and poor hygiene.
Onycholysis: Lifting of the nail from the underlying blast bed or from the sides. May be acquired by external irritants such as harsh chemicals and detergents. Can be a sign of skin disease, an infection, or injury. Most cases are seen in women with long fingernails.
Onychomadesis: Complete shedding of blast from nail bed, causing localized infection, minor injury to the matrix bed, or severe systemic illness.
Onychomycosis: A fungal infection of the boom, also called tinea unguium. The smash becomes crude, thick, and brittle.
Onychophosis: Growth of horny epithelium in the lateral or proximal nail folds.
Onychorrhexis: Breakable nails with splitting at its free edge, which may result from strong soap, nail smoothen remover, anemia, etc.
Onychoptosis: Shedding of the nails resulting from fever, trauma, or adverse reaction to drugs.
Onychoschizia: Splitting of the distal nail plate into layers at the free edge.
Onyxis: Ingrown blast.
Onychomatricoma: A benign nail matrix tumor clinically characterized past a thickened, curved nail plate, with multiple holes at the distal margin of the nail plate.
Paronychia: Bacterial or fungal infection of the finger or toe where the skin and smash see at the side or base. May progress to an abscess.
Subungual hematoma: A collection of claret nether the nail due to trauma.

Tip 3: Get Familiar with Common Services

Mutual boom procedures include trimming of nondystrophic and dystrophic nails, debridement of nail(s), avulsion of nail plate, evacuation, excision of boom and matrix, biopsy of nail unit, repair and reconstruction of nail bed, and wedge excision of nail fold skin.
If the provider orders trimming of nails, review the documentation to determine either dystrophic (G0127 Trimming of dystrophic nails, any number) or nondystrophic (11719 Trimming of nondystrophic nails, any number). Utilise either code appropriately for ane or more nails.
Debridement of nails is reported according to the number of nails treated. For v or fewer nails, report 11720 Debridement of nail(s) by any method(s); 1 to 5. For debridement of six or more nails, report 11721 Debridement of nail(south) by whatsoever method(s); 6 or more.
When reporting avulsion of nail plate, assign 11730 Avulsion of nail plate, partial or complete, simple; single for the outset process. For each additional boom plate avulsed, turn to improver code +11732 Avulsion of nail plate, fractional or complete, simple; each boosted nail plate (List separately in addition to lawmaking for principal procedure). For instance, if the provider performed 3 avulsions, report 11730, 11732 ten 2.
Report evacuation of subungual hematoma with 11740 Evacuation of subungual hematoma. Local anesthesia may be required.
Excision of nail and nail matrix may occur with or without amputation of tuft of distal phalanx:
11750 Excision of nail and nail matrix, partial or consummate (eg, ingrown or deformed nail), for permanent removal;
11752 Excision of nail and nail matrix, fractional or complete (eg, ingrown or deformed nail), for permanent removal; with amputation of tuft of distal phalanx
Per CPT® Assistant (December 2002), when amputation is part of the procedure:
The tuft at the end of the distal phalanx is dissected free and removed with a cutting instrument (eg, bone cutter or rongeur). The edges of the stump are smoothed with a rasp, and the adjacent soft tissues are brought over it and sutured in place. The wound is closed in layers.
Nail biopsy is a surgical procedure in which a tissue specimen is obtained from the growth plate of a fingernail or toenail, reported with 11755 Biopsy of smash unit of measurement (eg, plate, bed, matrix, hyponychium, proximal and lateral blast folds) (dissever process). Per CPT® Assistant, "When a biopsy of the nail bed is performed subsequently avulsion of the nail plate, it is inclusive of the avulsion procedure and is non coded separately."
For repair of nail bed, written report 11760 Repair of nail bed.
Report reconstruction of nail bed with 11762 Reconstruction of boom bed with graft. Per CPT® Assistant:
The intent of reconstruction of the blast bed is to right a defect from trauma, excision of a lesion, or other condition and, to the extent possible, restore its structural and functional integrity. The details of reconstruction will differ in each instance, depending on the nature and extent of the defect. More often than not, a separate thickness graft is obtained from the nail bed of the bang-up toe; all the same, full thickness grafts may be utilized in some cases.
Wedge excision of the nail fold pare (11765 Wedge excision of skin of nail fold) is performed typically to remove hypertrophic lateral boom folds that result from chronic ingrown toenails. CPT® Banana explains:
… a longitudinal incision is fabricated on the affected side of the digit, extending from the proximal nail fold along the nail groove to the distal end of the nail. A second incision is made so that information technology curves slightly outward from the lateral nail fold and meets the first incision at each end. The wedge of tissue is removed and the edges of the wound are approximated with sutures.

Tip 4: Research CMS Policies

Exist sure to bank check payer guidelines related to specific procedures. For example, Medicare Local Coverage Determination (LCD) L33833 for Surgical Treatment of Nails, relative to nail avulsion (11730, 11732) specifies:

When a complete nail avulsion is performed, some other avulsion should not be required for at least 12 weeks on the same digit. Services performed more ofttimes than every 12 weeks on the same digit are not reasonable and necessary and volition be denied.
In the unusual circumstance of a repeat partial avulsion of the aforementioned digit inside a 12-week period, the medical record must be specific as to the indication, such equally ingrown nail of opposite border or new meaning pathology on the same border recently treated.
Partial smash avulsion of divide borders of the same boom is a single procedure.
Both avulsion and routine trimming/debridement is not allowed on the same blast on the same day.

Tip five: Lookout man Out for Divide Eastward/Thousand

In some cases, an evaluation and management (E/M) service may be prompted by a symptom or condition occurring when a procedure or service is also provided during the aforementioned visit. You may report this circumstance past adding modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same twenty-four hours of the procedure or other service to the appropriate E/Grand service code. Dissimilar diagnoses are not required to report the E/One thousand service and process on the same engagement.

Sivaraj Ramesh, CPC, CEMC, CCS, is assistant manager, coding at Global Healthcare Resources. He has a professional degree in concrete therapy, a master'south degree in Psychology, and more than than 10 years of experience in medical coding.
Resources
CPT® Assistant, December 2002
CMS, Local Coverage Determination (LCD): Surgical Treatment of Nails (L33833):
www.cms.gov/medicare-coverage-database/