“What diagnosis code should be used for CPT 11719, NON-dystrophic toenail debridement?”
Essentially, a nondystrophic toenail is a normal toenail. It is not afflicted with onychomycosis, nor is it irregular or abnormal (aka dystrophic). CPT code 11719 is defined as: Trimming of nondystrophic nails, any number.
The description of the CPT code describes the procedure that is performed as “trimming” as opposed to “debridement” which further supports the fact that the toenails in question are “normal” as opposed to being irregular or abnormal. This CPT code is covered or reimbursable for a patient that qualifies for “At Risk,” Routine Foot Care based upon the premise that if an untrained person or the patient attempted to “trim” his or her own “normal” toenails, the patient runs the risk of an infection or the loss of a limb. Furthermore, the average reimbursement for CPT 11719 is approximately 14.00 allowed and reimbursed at 80% by Medicare which comes to approximately 11.00, as opposed to CPT 11721 (Debridement of nails by any method(s); 6 or more) which reimburses at approximately 44.00 allowed and reimbursed at 80% by Medicare which comes to approximately 35.00.
The most appropriate ICD-0-CM codes to support the billing and the reimbursement of CPT code 11719 are the following:
L60.9 Nail disorder, unspecified
L60.8 Other nail disorders
This is my opinion.
Michael G. Warshaw
DPM, CPC
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