Biopsy

CPT code 11755 is defined as the following: Biopsy of nail unit (e.g. plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure). It is amazing to me how often this CPT code is misused and abused.

“I have a patient with a possible 1st proximal phalanx cyst vs infection that I plan to do an exploratory procedure and collect some bone cultures / swabs on. MRI was inconclusive. If I get in there and the bone appears necrotic/infected, I will have on the consent form to allow for a PIPJ arthroplasty. So, we'll get prior auth for all these procedures prior to surgery. But, for the initial planned procedure, how would this be coded?”

“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?”