How To Use CPT Code 11750

CPT 11750 is a code used for the excision of nail and nail matrix, partial or complete, for permanent removal. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11750 procedures.

1. What is CPT 11750?

CPT 11750 is a medical code used to describe the procedure of excising part or all of a fingernail or toenail, including the nail plate and matrix, for permanent removal. This procedure is typically performed to treat ingrown or deformed nails, which can cause pain, inflammation, or infection.

2. 11750 CPT code description

The official description of CPT code 11750 is: “Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal.”

3. Procedure

The 11750 procedure involves the following steps:

  1. The patient is appropriately prepped and given local anesthesia.
  2. The provider excises the nail and nail matrix of a finger or toe using scissors and/or a scalpel.
  3. To prevent a new nail from forming, the physician uses phenol or electrocautery to destroy or permanently remove the nail matrix.
  4. Tears made in the matrix are closed with sutures.

4. Qualifying circumstances

Patients eligible to receive CPT code 11750 services are those experiencing pain, inflammation, or infection due to an ingrown or deformed nail. This procedure may also be performed to treat paronychia, laceration, crush injury, or other wounds of the nail components.

5. When to use CPT code 11750

It is appropriate to bill the 11750 CPT code when a patient requires partial or complete excision of the nail plate and matrix for permanent removal due to an ingrown or deformed nail, or other conditions affecting the nail components that cause pain, inflammation, or infection.

6. Documentation requirements

To support a claim for CPT 11750, the following information needs to be documented:

  • Patient’s medical history and symptoms related to the nail condition.
  • Physical examination findings, including the affected nail and surrounding tissue.
  • Diagnosis and indication for the procedure.
  • Details of the procedure performed, including anesthesia, instruments used, and steps taken during the excision.
  • Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 11750, it is essential to follow the appropriate guidelines and rules. These may include:

  • Adding a modifier 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.
  • Ensuring that the procedure meets “reasonable and medically necessary” standards by checking the LCD or payer’s guidelines and making sure the documentation, including the diagnosis, supports the procedure.

8. Historical information

CPT 11750 was added to the Current Procedural Terminology system on January 1, 1990. There have been updates to the code description since then, with the most recent change occurring on January 1, 2010.

9. Similar codes to CPT 11750

Five similar codes to CPT 11750 and how they differentiate are:

  1. CPT 11730: This code is used for simple partial avulsion of a single nail plate, which is less invasive than CPT 11750.
  2. CPT 11732: This code is used for each additional nail plate avulsion, in conjunction with CPT 11730.
  3. CPT 11740: This code is used for the evacuation of subungual hematoma, which involves draining blood from under the nail rather than excising the nail and matrix.
  4. CPT 11760: This code is used for the repair of nail bed, which focuses on repairing the underlying nail bed rather than removing the nail and matrix.
  5. CPT 11765: This code is used for wedge excision of the nail fold, which involves removing a portion of the nail fold rather than the nail plate and matrix.

10. Examples

Here are 10 detailed examples of CPT code 11750 procedures:

  1. Excision of an ingrown toenail on the left big toe, including the nail plate and matrix, for permanent removal.
  2. Partial excision of a deformed nail on the right index finger, including the nail plate and matrix, for permanent removal.
  3. Complete excision of a nail and nail matrix on the left little toe due to a crush injury.
  4. Partial excision of a nail and nail matrix on the right thumb due to chronic paronychia.
  5. Excision of a nail and nail matrix on the left ring finger due to a laceration involving the nail components.
  6. Complete excision of a nail and nail matrix on the right big toe due to a severe fungal infection.
  7. Partial excision of a nail and nail matrix on the left middle finger due to a painful, deformed nail.
  8. Excision of a nail and nail matrix on the right little toe due to a chronic ingrown toenail causing recurrent infections.
  9. Complete excision of a nail and nail matrix on the left index finger due to a severe nail deformity causing pain and functional impairment.
  10. Partial excision of a nail and nail matrix on the right big toe due to an ingrown toenail causing significant pain and inflammation.

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