How To Use cpt 11765

cpt 11765 describes the wedge excision of the skin of the nail fold at the lateral margin (groove) of a nail, such as an ingrown toenail. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of cpt 11765.

1. What is cpt 11765?

cpt 11765 is a code used to describe the wedge excision of the skin of the nail fold at the lateral margin (groove) of a nail. This procedure is typically performed to treat conditions such as ingrown toenails, paronychia, lacerations, crush injuries, or other wounds of the nail components. It involves removing soft tissue from the nail margins through an elliptical incision and closing the wound with sutures to promote healing.

2. Official Description

The official description of cpt 11765 is: ‘Wedge excision of skin of nail fold (eg, for ingrown toenail).’ This code specifically refers to the excision of the skin of the nail fold at the lateral margin of a nail, commonly known as the groove.

3. Procedure

1. The provider administers local anesthesia to the affected nail groove.
2. An elliptical incision is made through the subcutaneous tissue of the nail groove.
3. A wedge-shaped incision is performed to remove the soft tissue from the nail margins.
4. The wound is closed with sutures to promote healing.

4. Qualifying circumstances

cpt 11765 is typically performed to treat conditions such as ingrown toenails, paronychia, lacerations, crush injuries, or other wounds of the nail components. It is important to note that this procedure does not include the excision of the nail plate or matrix. The decision to perform cpt 11765 is based on the clinical judgment of the provider, considering the patient’s symptoms and the need for surgical intervention.

5. When to use CPT code cpt 11765

cpt 11765 should be used when the provider performs a wedge excision of the skin of the nail fold at the lateral margin (groove) of a nail. This code is appropriate for cases involving conditions such as ingrown toenails, paronychia, lacerations, crush injuries, or other wounds of the nail components. It is important to review the documentation and clinical circumstances to ensure accurate coding.

6. Documentation requirements

To support a claim for cpt 11765, the provider must document the following information:

• Diagnosis indicating the need for the procedure
• Description of the procedure performed, including the specific location and extent of the excision
• Details of the incision and closure technique used
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for cpt 11765, ensure that the procedure performed aligns with the description of the code. It is important to accurately document the diagnosis and procedure details to support the medical necessity of the service. Modifier codes may be necessary to indicate the specific foot and toe treated. It is also essential to review payer guidelines and local coverage determinations to ensure compliance with billing requirements.

8. Historical information

cpt 11765 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to cpt 11765

Five similar codes to cpt 11765 include:

• cpt 11730: Simple partial avulsion of a single nail plate
• cpt 11750: Partial or complete excision of nail plate and matrix for permanent removal
• cpt 11755: Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds)
• cpt 11760: Repair of nail bed
• cpt 11770: Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail)

9. Examples

1. A patient presents with an ingrown toenail, and the provider performs a wedge excision of the skin of the nail fold at the lateral margin (groove) of the affected nail.
2. A patient sustains a laceration to the nail fold, and the provider performs a wedge excision to remove the damaged tissue and promote healing.
3. A patient develops paronychia, and the provider performs a wedge excision of the skin of the nail fold to treat the infection and alleviate symptoms.
4. A patient experiences a crush injury to the nail, and the provider performs a wedge excision to remove the damaged tissue and facilitate healing.
5. A patient presents with a wound involving the nail components, and the provider performs a wedge excision to remove the affected tissue and promote proper healing.
6. A patient requires surgical intervention for a chronic ingrown toenail, and the provider performs a wedge excision of the skin of the nail fold to address the underlying issue.
7. A patient with paronychia requires surgical treatment, and the provider performs a wedge excision of the nail fold to remove the infected tissue and promote healing.
8. A patient sustains a laceration to the lateral nail fold, and the provider performs a wedge excision to repair the damaged tissue and restore normal function.
9. A patient presents with a crush injury to the nail bed, and the provider performs a wedge excision to remove the damaged tissue and facilitate healing.
10. A patient requires surgical intervention for an ingrown toenail, and the provider performs a wedge excision of the skin of the nail fold to alleviate symptoms and prevent further complications.