“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”
In the old days, that is prior to January 1, 2017, when a partial or complete matrixectomy was performed in addition to removing a portion of the distal phalanx of the toe, the CPT code to bill was CPT code 11752 which was defined as: Excision of nail and nail matrix, partial or complete, (eg. ingrown or deformed nail), for permanent removal; with amputation of tuft of distal phalanx. Unfortunately, this CPT code was deleted. We now have to come up with Plan B.
Here are the CPT codes that I would select:
CPT code 28124 which is defined as: Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g. osteomyelitis or bossing); phalanx of toe
CPT code 11750 which is defined as: Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal
When the NCCI Edits are accessed, CPT codes 28124 and 11750 are not bundled. Therefore, it would be appropriate to bill for both of these CPT codes.
As far as the ICD-10-CM codes are concerned, here are my selections:
For CPT code 28124:
M89.371: Hypertrophy of bone, right ankle or foot
M89.372: Hypertrophy of bone, left ankle or foot
For CPT code 11750:
L60.0: Ingrowing nail
The coding scenario would be the following:
CPT 28124 – RT/LT
CPT 11750 – 59, RT/LT
This is my opinion.
Michael G. Warshaw
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