Since CPT code 11703 is a targeted CPT/procedure code by Medicare, what do I need to know to make sure that I don’t get in trouble?
When you look at the “Top Ten reasons That Podiatrists Are Audited and Fail the Audit,” number 4 on the list is CPT code 11730.
CPT code 11730 is defined as the following: Avulsion of nail plate, partial or complete, simple; single. It is classified as a minor surgical procedure/code with a postoperative global period of “0” days. If more than one nail avulsion is performed on the same date of service, it is important to be aware that CPT code 11730 can only be billed one time on a given date of service. There is an additional CPT code if more than one toenail avulsion is performed on the same date of service. CPT code 11732 is defined as the following: Avulsion of nail plate, partial or complete, simple; each additional nail plate (list separately in addition to code for primary procedure).
Partial or Total Nail Avulsions
CPT Code 11730
- • Documentation must describe the symptoms and complaint which establish medical necessity
for the treatment.
- • Nail or Nail border must be separated and removed to and under the eponychium.
- • Local anesthetic (type and quantity) must be documented. This is not “cold spray” or a topical anesthetic. This is the injection of lidocaine, etc. If a local anesthetic injection is not used, provide rationale for the specific reason why (ie. Neuropathic patient, patient refused, medical contraindications). This must be accurately documented in the medical record for the date of service in question.
- • Post-operative instructions and follow-up care must be documented.
- • If medial and lateral border are removed on the same nail, only one service can be billed.
- • Cannot bill an I&D and avulsion or partial avulsion on the same nail.
- • CPT codes 11730 and 11732 for nail avulsion will be denied if billed for the same toe less than 8 months (32 weeks) following a previous avulsion.
This is my opinion.
Michael G. Warshaw
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