How To Use CPT Code 11730

CPT 11730 refers to the simple avulsion of a single nail plate, either partial or complete. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11730 procedures.

1. What is CPT 11730?

CPT 11730 is a medical procedure code used to describe the simple avulsion of a single nail plate, either partial or complete. This procedure is typically performed to treat conditions such as ingrown toenails, paronychia, lacerations, crush injuries, or other wounds of the nail components. Medical professionals use this code to accurately document and bill for the services provided during this procedure.

2. 11730 CPT code description

The official description of CPT code 11730 is: “Avulsion of nail plate, partial or complete, simple; single.”

3. Procedure

The 11730 procedure involves the following steps:

1. Preparation of the patient, including administration of a standard digital block for local anesthesia.
2. Separation of the nail plate from the nail bed using a nail elevator or iris scissors.
3. Application of electrocautery to control bleeding.
4. Simple repair of any small wounds, if necessary.

If the wound requires immediate reconstruction with local flaps, the provider can report that procedure separately.

4. Qualifying circumstances

Patients eligible to receive CPT code 11730 services are those who require the partial or complete, simple removal of a single nail plate due to conditions such as ingrown toenails, paronychia, lacerations, crush injuries, or other wounds of the nail components. The procedure must be deemed “reasonable and medically necessary” according to the Local Coverage Determination (LCD) or payer’s guidelines, and the documentation must support the diagnosis and procedure.

5. When to use CPT code 11730

It is appropriate to bill the 11730 CPT code when the provider performs a simple avulsion of a single nail plate, either partial or complete, to treat conditions such as ingrown toenails, paronychia, lacerations, crush injuries, or other wounds of the nail components. The procedure must meet the “reasonable and medically necessary” standards as per the LCD or payer’s guidelines, and the documentation must support the diagnosis and procedure.

6. Documentation requirements

To support a claim for CPT 11730, the following information must be documented:

• Patient’s medical history and relevant diagnoses.
• Indications for the procedure, including the specific condition being treated.
• Detailed description of the procedure performed, including the steps taken and any complications encountered.
• Post-procedure care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 11730, medical professionals should adhere to the following guidelines:

• Use add-on code 11732 for the same procedure on each additional nail plate.
• Apply modifiers from T1 to T9 and TA to identify the foot and toe that was treated. If the procedure was performed on the nails of the hand, use modifiers F1 to F9 and FA.
• Compare the procedure and indications for CPT codes 11730, 11750, and 11765 to determine the most appropriate code for the procedure performed.
• Ensure that the procedure meets “reasonable and medically necessary” standards by checking the LCD or payer’s guidelines and ensuring that the documentation supports the diagnosis and procedure.

8. Historical information

CPT 11730 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 11730

Five similar codes to CPT 11730 and how they differentiate are:

• CPT 11732: Add-on code for the same procedure on each additional nail plate.
• CPT 11750: Involves partial or complete excision of the nail plate and matrix for permanent removal.
• CPT 11765: Refers to the wedge excision of the nail fold.
• CPT 11760: Involves the repair of the nail bed.
• CPT 11770: Refers to the excision of the pilonidal cyst or sinus.

10. Examples

Here are 10 detailed examples of CPT code 11730 procedures:

1. Simple avulsion of a single nail plate on the left big toe due to an ingrown toenail.
2. Partial avulsion of a single nail plate on the right index finger due to a laceration.
3. Complete avulsion of a single nail plate on the left little toe due to a crush injury.
4. Simple avulsion of a single nail plate on the right thumb due to paronychia.
5. Partial avulsion of a single nail plate on the left ring finger due to a nail bed infection.
6. Complete avulsion of a single nail plate on the right middle toe due to a fungal infection.
7. Simple avulsion of a single nail plate on the left second toe due to a subungual hematoma.
8. Partial avulsion of a single nail plate on the right big toe due to a traumatic injury.
9. Complete avulsion of a single nail plate on the left third toe due to a chronic ingrown toenail.
10. Simple avulsion of a single nail plate on the right pinky finger due to a severe nail deformity.