“I have a patient with a longitudinal striation of her toenail, and we are going to biopsy the nail bed. What ICD-10 do code would you consider for the diagnosis for the biopsy? What is the CPT procedure code for the nail matrix?”
So, a nail biopsy is going to be performed due to a longitudinal, striation present within a toenail. What about the ICD-10-CM code to submit with the specimen to the pathology lab for the diagnosis of the biopsy? ICD-10-CM code D48.2 is defined as the following: Neoplasm of unspecified behavior of bone, soft tissue, and skin. This appears to be the most appropriate choice for an initial diagnosis. The biopsy of the specimen needs to be performed to determine whether the specimen is benign or malignant. That is why an “unspecified diagnosis” is appropriate at this time. Obviously, once the specimen that was submitted is analyzed by the pathology lab, a more definitive diagnosis is available.
As far as the CPT code for the nail matrix is concerned, it is important to look at the definition of CPT 11755: Biopsy of nail unit (eg. plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure).
CPT Assistant, December 2002 clearly defines what a nail biopsy is and how it is performed.
The article states that “The nail plate and nail bed may be biopsied using one of several techniques.
• A small punch may be used to obtain a tissue sample. The punch is placed on the nail plate and pushed down through the plate and into the nail bed. The punch is removed, and the specimen is gently pried out of the hole with a small needle and then cut out with scissors.
• For larger biopsies, a longitudinal incision is made over the affected area with a scalpel and extended down to the periosteum. The specimen is removed, and the wound is closed with sutures.
• When the nail matrix is biopsied, short longitudinal incisions may be made on either side of the proximal nail fold in line with the lateral nail folds. The tissue is elevated and lifted off the proximal nail plate, a portion of which is removed for access to the nail matrix. A punch or scalpel is used to remove the biopsy specimen. The wound is closed with sutures.”
The bottom line is that the biopsy of a nail unit is a single biopsy which samples all the parts of the nail unit including the matrix, bed, fold, and plate. Therefore, there is not an individual, separate CPT code for the nail matrix. It is included in the nail unit and is not separately reimbursable.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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