As a podiatrist, accurately coding nail debridement procedures is crucial for proper reimbursement. Thus, understanding its nuances is essential to prevent claim denials and maximize revenue.
This is your ultimate guide to CPT code 11720. We will thoroughly cover its description, share real-world clinical scenarios where this code applies, and list the applicable modifiers for accurate reporting. Finally, we will break down the essential billing and reimbursement guidelines for 2025.
So what are you waiting for? Let’s master CPT code 11720 together.
CPT Code 11720 – Description
CPT code 11720 is from the ‘Surgical Procedures on the Nails’ code range. Like all the other code ranges, it is also maintained by the American Medical Association (AMA). It covers the surgical removal (debridement or debulking) of 1 to 5 nails that are infected, diseased, or abnormal.
Scenarios Where CPT Code 11720 is Applicable
Discussed below are some clinical scenarios where the CPT code 11720 can be appropriately reported:
Ingrown Toenails with Infection
Picture a 26-year-old female patient with swollen, erythematous, and painful nail folds on both sides of her left great toenail. The podiatrist noted a purulent discharge from both areas, indicating infection secondary to the ingrown nails.
Therefore, the podiatrist performs surgical debridement of the ingrown portions of the left great toenail. Also, he removes the offending nail spicules and associated debris to promote drainage and healing.
Here, CPT code 11720 applies.
Multiple Toenail Onychomycosis
Imagine a 55-year-old male patient with a history of diabetes mellitus visiting the podiatry clinic. He complains about discolored, dystrophic, and thickened toenails on his right foot.
The podiatrist notes significant onychomycosis affecting the second and fourth toenails. As a result, the physician performs surgical debridement of these two nails (CPT code 11720). The podiatrist removes the diseased portions using a nail nipper and curette.
Traumatic Nail Dystrophy
Consider a 28-year-old female patient who visits an urgent care facility after stubbing her toenail. Examination reveals a severely thickened and deformed right great toenail as the source of her reported pain and pressure.
The healthcare provider performs surgical debridement of the dystrophic nail tissue using a scalpel and nail elevator to remove the damaged portion.
The provider reports CPT code 11720 to bill for the services.
Applicable Modifiers for CPT Code 11720
The following are all applicable modifiers for nail debridement:
Modifier 59 or XS
You can append modifier 59 or XS to CPT code 11720 in specific situations where you perform two distinct procedures on the same foot during the same visit.
For instance, modifier 59 or XS applies when you remove toenails and pare (thin or trim) a hyperkeratotic lesion on a toe.
Modifiers F/T
Your documentation for CPT code 11720 must reference which toenails or fingernails the physician removed. The table below shows the F/T modifiers that you may append specifically for this purpose:
| Toe Modifiers | Description | Finger Modifiers | Description |
|---|---|---|---|
| TA | Left foot, great toe | FA | Left hand, thumb |
| T1 | Left foot, second digit | F1 | Left hand, second digit |
| T2 | Left foot, third digit | F2 | Left hand, third digit |
| T3 | Left foot, fourth digit | F3 | Left hand, fourth digit |
| T4 | Left foot, fifth digit | F4 | Left hand, fifth digit |
| T5 | Right foot, great toe | F5 | Right hand, thumb |
| T6 | Right foot, second digit | F6 | Right hand, second digit |
| T7 | Right foot, third digit | F7 | Right hand, third digit |
| T8 | Right foot, fourth digit | F8 | Right hand, fourth digit |
| T9 | Right foot, fifth digit | F9 | Right hand, fifth digit |
Modifiers Q7, Q8, Q9
You must append one of the Q modifiers (Q7, Q8, Q9) with CPT code 11720 to ensure that Medicare covers routine foot care because the patient has a qualifying systemic condition. For the unversed, a qualifying systemic condition is a disease that affects the whole body, such as diabetes or peripheral artery disease.
Here’s what the Q modifiers entail:
| Modifiers | Description |
|---|---|
| Q7 | One (1) Class A finding |
| Q8 | Two (2) Class B findings |
| Q9 | One (1) Class B finding and two (2) Class C findings |
CPT Code 11720 – Billing & Reimbursement Guidelines
Below you can find the billing and reimbursement tips related to the nail debridement procedure covered under CPT 11720:
Ensure Comprehensive Documentation
Detailed documentation is key to getting your claims processed on time. Your documentation must demonstrate the medical necessity of the debridement, the diagnoses reported, and any class findings (if applicable). It should include:
- Patient’s medical history.
- Details of which nails are removed.
- Also include findings that support the medical necessity, such as infection, pain, class findings, etc.
- Date of service.
- Lab test reports.
- Provide details about the systemic condition, if applicable. It must include whether the patient is under the active care of a physician for that condition. If yes, mention the last visit date and the diagnosis.
Note: At least one nail removal documentation is acceptable for CPT code 11720. However, its scope allows the removal of a maximum of five nails only. CPT code 11721 applies when you remove six or more nails.
Append Appropriate Modifiers
Modifiers offer coding specificity, and payers emphasize that you provide the highest level of detail when billing for a service. Some of the modifiers that apply to the CPT 11720 are 59, XS, Q7, Q8, Q9, and the F/T modifiers.
You can check the ‘Applicable Modifiers for CPT Code 11720’ section for more details on the modifier usage.
Understand Payers’ Specific Policies
Given the significant differences in reimbursement and billing rules among Medicare, Medicaid, and private payers, due diligence is required. Some good practices include reviewing specific payer policies, verifying patient eligibility, and obtaining pre-authorization when necessary to get a head start.
Besides, train your staff to communicate with the payer to stay current on any changes in the billing requirements, as payers frequently update their policies.
Summary
Finally, it is time for a wrap-up. You may feel overwhelmed after skimming through this guide because there are so many details to follow. But don’t worry. We will list the key takeaways here for your ease.
First, we explained that CPT code 11720 covers the surgical removal of 1 to 5 infected, diseased, or abnormal nails.
Next, we looked into some clinical scenarios where CPT 11720 applies. These include ingrown toenails with infection, multiple toenail onychomycosis, and traumatic nail dystrophy.
We also shared a list of all applicable modifiers for the nail debridement procedure, including 59, XS, Q7, Q8, Q9, and F/T modifiers.
Finally, we discussed the billing and reimbursement guidelines to ensure you receive timely and fair payment for every nail debridement procedure you perform.
Hopefully, these details will help you effectively navigate the complex billing landscape. However, if you require professional assistance, feel free to acquire professional podiatry billing services from MediBillMD.
