Are you a podiatrist constantly battling with the correct usage of CPT codes in podiatry? Do not worry! We have put together this comprehensive guide on CPT code 11730.
This code deals with the avulsion of nail plates for various causes, such as severe ingrown nails, widespread fungal infections, trauma, or to treat the aftereffects of nail bed damage.
You will learn everything you need about CPT code 11730, including how to use it practically, what modifiers apply, and how to get reimbursed to avoid claim denials.
CPT Code 11730 – Description
CPT code 11730 describes a surgical process of removing a nail plate. The doctor performs partial or whole removal of a fingernail or toenail because of fungal illnesses, trauma, or ingrown nails. The physician usually applies anesthesia to reduce the pain or discomfort caused during the procedure.
This code deals with only one avulsion on one nail, and one unit of service (UOS) is billed.
Scenarios Where CPT Code 11730 is Applicable
Nail plate avulsion covered by CPT code 11730 becomes necessary in the following clinical scenarios.
Ingrown Nails
Let’s say a 25-year-old man visits a clinic. He informs the physician that he cut his nails too short, which is now making him uncomfortable and causing inflammation on his skin. After a comprehensive examination, the physician determines that the source of the pain is an ingrown nail. The physician removes a tiny portion of the infected nail to stop the infection from spreading. In this case, CPT code 11730 will be used.
Nail Injury
Let’s say a football player sustains a nail injury while participating in the game. At first, he continued to play despite not realizing the injury. He discovers that he has seriously damaged his nail after the contest. The podiatrist removed the nail plate after he was rushed to the closest clinic. After the avulsion, CPT code 11730 will be reported to submit a claim for reimbursement in this injury scenario.
Fungal Infection
Suppose an elderly man visits the clinic with a fungal infection in his fingernail, leading to pain and discoloration. He tells the physician that he has tried everything on his own but still failed to treat this infection. The physician decides to remove the affected part of his nail. In this case, the physician can use CPT code 11730 for reimbursement.
Applicable Modifiers for CPT Code 11730
There are various modifiers that a physician or podiatrist may append with CPT code 11730 to provide extra details of the procedure. Below is the list of applicable modifiers commonly used with CPT code 11730.
F/T Modifiers
The HCPCS Level II “F/T” modifiers explain to insurance companies which finger/toe the nail plate avulsion was performed on. These modifiers indicate the location (left or right) and digit of the hand/foot (fingers and toes). The Centers for Medicare and Medicaid Services (CMS) introduced these modifiers to reduce the claim processing time and ensure that payers comprehend the specifics of the procedure with ease.
Use the following modifiers as needed, depending on the debridement or avulsion’s anatomy:
| Modifiers for Fingernails | |
|---|---|
| F1 | Left hand, second digit |
| F2 | Left hand, third digit |
| F3 | Left hand, fourth digit |
| F4 | Left hand, fifth digit |
| F5 | Right hand, thumb |
| F6 | Right hand, second digit |
| F7 | Right hand, third digit |
| F8 | Right hand, fourth digit |
| F9 | Right hand, fifth digit |
| FA | Left hand, thumb |
| Modifiers For Toenails | |
| T1 | Left foot, second digit |
| T2 | Left foot, third digit |
| T3 | Left foot, fourth digit |
| T4 | Left foot, fifth digit |
| T5 | Right foot, great toe |
| T6 | Right foot, second digit |
| T7 | Right foot, third digit |
| T8 | Right foot, fourth digit |
| T9 | Right foot, fifth digit |
| TA | Left foot, great toe |
KX Modifier
The KX modifier denotes therapy services that exceed the annual Medicare threshold amounts and are medically necessary. However, the practitioner must accurately indicate in the patient’s medical record why these treatments are necessary.
CPT Code 11730 – Billing & Reimbursement Guidelines
The following are the coding and billing guidelines for CPT code 11730 that may help you prevent claim denials.
Ensure Correct Use of CPT Code
The physician must use CPT code 11730 correctly for reimbursement because there are several nail procedures. Certain clinical situations, for instance, call for the drainage and incision of the nail or the total removal of the nail bed. However, this code only deals with the avulsion of the entire nail plate or just a section.
The insurance payer may reject the claim if a nail plate avulsion (CPT code 11730) is billed for the same finger in less than 4 months (16 weeks) or the same toe in less than 8 months (32 weeks) after a prior avulsion.
Use the Appropriate Modifiers
Using the correct modifier for each service is as important as using the appropriate code for reimbursement. Suppose a service provider performs a procedure on the second digit of the foot and the big toe of the other foot and appends modifier 50 to indicate the bilateral procedure.
This is an incorrect use of this modifier and may result in claim denials. HCPCS has introduced F/T modifiers for such cases.
Report One Unit of Service
Report the procedure denoted by CPT code 11730 using one unit of service (UOS) and add the relevant identifying digit modifiers. On the other hand, if more than one nail is avulsed, the provider will claim under 11732 for each additional nail.
Maintain Detailed Documentation
Documents should explain the extent of the nail infection, injury, or deformity during the physical examination, and the assessment and treatment plan should include a thorough justification for the surgical procedure as the preferred course of action over alternative options.
Final Word
In conclusion, CPT code 11730 refers to an avulsion of the nail plate. However, since this procedure is limited to one nail plate, the physician can not remove several nail plates in a single visit.
The physician can only bill this code once in 4 months for an avulsion performed on the same fingernail and once in 8 months for a nail plate removal performed on the same toenail. However, if the service is medically essential than the advised Medicare level, the physician may add modifier KX to bypass the threshold.
Additionally, to facilitate the billing process for insurance payers, HCPCS has developed “F/T” modifiers that cover all the details about the procedure, for example, the placement of the finger or toenail where the procedure was performed.
Hopefully, this blog has covered all the necessary information about CPT code 11730. However, if you still need expert billing and coding assistance, you can acquire our podiatry billing services to file clean and compliant claims.
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