How To Use cpt 11755

cpt 11755 describes the biopsy of the nail unit, including the nail plate, bed, hyponychium, proximal nail folds, and lateral nail folds. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of cpt 11755.

1. What is cpt 11755?

cpt 11755 is a procedural code used when a physician performs a biopsy of the nail unit. This includes the nail plate, nail bed, hyponychium, proximal nail folds, and lateral nail folds. Each component of the nail unit is considered a separate procedure.

2. Official Description

The official description of cpt 11755 is: ‘Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)’

3. Procedure

During a nail unit biopsy, the physician cuts through the nail plate and biopsies the nail bed, hyponychium, proximal nail folds, and lateral nail folds. The procedure involves removing a portion or the entirety of suspicious tissue for pathologic examination. The physician then sutures the wound closed to promote proper healing.

4. Qualifying circumstances

cpt 11755 is performed when there is a need to biopsy the nail unit for diagnostic purposes. This may be necessary when there are suspicious lesions or abnormalities present in the nail plate, nail bed, hyponychium, proximal nail folds, or lateral nail folds. The procedure is typically performed by a physician who has determined that a biopsy is necessary based on the patient’s symptoms, medical history, and physical examination.

5. When to use cpt code 11755

cpt 11755 should be used when a physician performs a biopsy of the nail unit, including the nail plate, nail bed, hyponychium, proximal nail folds, and lateral nail folds. It is important to note that each component of the nail unit is considered a separate procedure, and should be coded accordingly.

6. Documentation requirements

To support a claim for cpt 11755, the physician must document the following information:

  • Reason for the biopsy and the specific component(s) of the nail unit biopsied
  • Details of the procedure, including the technique used and any complications encountered
  • Date and time of the biopsy
  • Pathologic examination results, if available
  • Any additional treatment or follow-up plans
  • Signature of the performing physician

7. Billing guidelines

When billing for cpt 11755, ensure that the biopsy is performed by a physician and includes the appropriate components of the nail unit. It is important to code each component of the nail unit biopsy separately. Additionally, consider any specific payer guidelines or requirements for reporting this code.

8. Historical information

cpt 11755 was added to the Current Procedural Terminology system on January 1, 1994. On January 1, 2002, the code description was revised to include the specific components of the nail unit.

9. Similar codes to cpt 11755

Five similar codes to cpt 11755 include:

  • cpt 11756: Biopsy of nail unit, each additional nail (List separately in addition to code for primary procedure)
  • cpt 11757: Removal of nail plate, partial or complete, simple; single
  • cpt 11758: Removal of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)
  • cpt 11760: Repair of nail bed
  • cpt 11765: Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal

9. Examples

  1. A physician performing a biopsy of the nail plate, nail bed, and proximal nail folds to investigate a suspicious lesion.
  2. A dermatologist performing a biopsy of the hyponychium and lateral nail folds to evaluate a chronic nail infection.
  3. A podiatrist performing a biopsy of the nail bed and proximal nail folds to assess a nail deformity.
  4. A plastic surgeon performing a biopsy of the nail plate and hyponychium to investigate a nail discoloration.
  5. An oncologist performing a biopsy of the nail bed, proximal nail folds, and lateral nail folds to evaluate a suspected nail melanoma.
  6. A dermatologist performing a biopsy of the nail plate and hyponychium to investigate a nail dystrophy.
  7. A hand surgeon performing a biopsy of the nail bed and proximal nail folds to assess a chronic paronychia.
  8. A rheumatologist performing a biopsy of the nail plate and lateral nail folds to evaluate nail changes associated with an autoimmune disease.
  9. A plastic surgeon performing a biopsy of the nail bed and hyponychium to investigate a nail tumor.
  10. An orthopedic surgeon performing a biopsy of the nail plate, nail bed, and proximal nail folds to assess a nail injury.

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