Can CPT codes 11730 and 11750 be billed together on the same toe as part of the same procedure?
So, a patient has an ingrown toenail on the medial border of the great toe. It is going to be surgically addressed. Phenol is going to be applied to destroy the matrix of the offending nail border. The big question is: Since the offending nail border needs to be removed prior to the application of phenol, can both CPT 11730 and CPT 11750 be billed for the performance of the procedure?
Let’s look at the two CPT codes in question:
CPT 11730 is defined as the following: Avulsion of nail plate, partial or complete, simple; single.
CPT 11750 is defined as the following: Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal.
Clearly, when CPT 11750 is performed, the offending nail border is removed to gain access to the nail matrix to apply the phenol to complete the procedure. Therefore, by billing both CPT 11730 and CPT 11750, it would be essentially double dipping.
Medicare established the National Correct Coding Initiative (NCCI Edits) which identifies procedures via the CPT codes to determine whether it is appropriate to bill more than one procedure at the same surgical site at the same surgical session. When the NCCI Edits are accessed, CPT 11750 is the Column 1 code or the primary procedure that is being performed. CPT 11730 is in the Column 2 code or the secondary procedure. Based upon the NCCI Edits these two CPT codes are bundled. Thus, CPT 11730 cannot be separately reimbursed in addition to CPT 11750. This further supports the fact that CPT 11750 is the only CPT code that can be billed in the above-mentioned scenario.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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