#podiatry coding

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Furnish complete details of the procedure being performed to avoid payment loss.

You can secure complete reimbursement for routine foot care services only under specific circumstances. Don’t forget to check whether systemic conditions were present prior to submitting your claim.

CPT® Codes for Nail Treatment Procedures

When your podiatrist treats ingrown nails, you’ll normally report the procedure with one of these CPT® codes: 11730, 11732, 11750, and 11765. Remember: These codes are not confined to just toenails. Use these codes to report either a toenail or fingernail, whichever applies. If it gets too confusing for you, keep a podiatry coding book handy.

Routine Foot Care?

Some ingrown toenail treatments are considered part of routine foot care, and therefore billable only with G0127, and 11720-11721 for some payers. If the doctor treats simple uncomplicated or asymptomatic in growing nail by removal of the offending nail spicule, which does not require local anesthesia, it’s called routine foot care. Routine foot care is covered only when certain systemic conditions exist.

ABCs of Nail Procedures

Procedure codes 11730 and 11732 describe a single, simple, avulsion (removal) of the nail plate. The podiatrist administers a standard digital block, and utilizes a nail elevator, iris scissors or nail cutters to segregate the nail plate from the nail bed. Small wounds, if any, are restored with a simple repair.

Here’s an Example:

A patient has five ingrown toenails. Your clinician conducted simple avulsion on both sides of the great toe on each foot and the second digit on the left foot. Here, you’ll report 11730 for the first avulsion and +11732 for each of the two additional avulsions. In case you want to indicate to the payer which toes are involved, you can apply HCPCS modifiers TA (left foot, great toe), T5 (right foot, great toe), and T1. Since +11732 is an add-on code, there are no CCI edits between 11730 and +11732, and you need not apply any modifiers.

Documentation Best Practices

For CPT® codes 11730, 11732, 11750, and 11765, as per Medicare, an operative report or complete detailed description of the procedure being performed is required. If you do not include any of the below listed information in the patient’s medical record, you could be in for denials:

·         Chief complaint of the patient (for instance painful toe)

·         Procedure being performed

·         Method of obtaining anesthesia and if not used, the reason for not using it

·         Detailed procedure description

·         Postoperative observation and treatment of the surgical site

·         Postoperative instructions provided to the patients and any follow-up care