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CPT Code 11721 | Description, Procedure & Billing Guidelines (2022)

Report CPT code 11721 for debridement of six or more infected, abnormal, or diseased nails with any method.

1. What Is CPT Code 11721?

CPT 11721 covers a procedure in which a provider surgically debrides (removes or debunks) six or more infected, abnormal, or diseased nails.

2. Description

The CPT book describes 11721 as follows: “Debridement of nail(s) by any method(s); 6 or more.”

3. Procedure

The 11721 CPT code procedure starts with a provider preparing the necessary surgical instruments or electrical grinders for treating the patient’s abnormally diseased or infected nails.

Then, the provider starts with the first toenail and manually removes, debulks, or debrides the nail with an electrical grinder or another surgical instrument.

Next, they repeat the procedure with the other five or more nails.

4. How To Use CPT Code 11721

Use CPT 11721 only for the debridement of six or more nails. You can use CPT code 11720 for the debridement of one to five nails.

Add the appropriate ‘toe modifiers’ (Modifier T1 until T9 and TA) to show which of the toenails were treated.

If the procedure was performed on the nails of the hand, report CPT code 11721 with finger modifiers F1 to F9 or modifier FA.

Medicare and most other payers do not cover general routine nail care. The 11721 procedure is only covered if the nails;

  • are infected with a fungus (mycotic);
  • causing a lot of pain;
  • making walking difficult (only for patients with vascular or neurological illness or diabetes).

Medicare may also cover this procedure if the nails are deformed, resemble horns or claws, or are excessively thick and separated from the nail bed.

Make sure to provide Medicare or other payers with enough information to show that the 11721 procedure was medically necessary.

5. Resources

CPT Professional 2022

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