APMA's Coding Briefs offer valuable insights and guidelines that navigate podiatrists through coding and billing. This information is aimed at increasing the accuracy of reimbursement, ensuring the top compliance with regulations, and improving documentation, which may help to reduce the burden of denials.
When treating an ulcer on the lower limb that is secondary to chronic venous insufficiency or lymphedema, it may be necessary to perform ulcer debridement and apply lower limb compression at the same site at the same encounter. All of the ulcer debridement CPT® codes (CPT 97597, 97598, 11042-11047) are paired with the Unna boot / multi-layer compression CPT codes (CPT 29580 / 29581) by the NCCI PTP edits with the ulcer debridement codes in column 1 of the pairing. When two services are performed at the same site at the same encounter, and the codes that represent those services are paired by an NCCI PTP edit, only the column 1 code of the pairing is submitted. In this situation, appending a 59 Modifier to CPT 29580/ 29581 is inappropriate unbundling of the NCCI PTP edit.
Use CPT 11730 for a temporary nail plate avulsion and CPT 11732 for any additional temporary nail plate avulsion (add-on code) performed at the same encounter.
CPT 11750 is used for a permanent nail plate avulsion. This code is the same for the initial and all additional permanent nail plate avulsions performed at the same encounter.
Current Procedural Terminology (CPT®) is copyright by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
When choosing hardware removal codes, providers often must select between CPT® 20670 (Removal of implant; superficial (e.g., buried wire, pin, or rod) (separate procedure))* and CPT® 20680 (Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod, or plate))* for services that do not fall under a global period. For removal of hardware such as a K-wire from a previous bunionectomy, under local anesthesia in an office setting, CPT® 20670 is appropriate. If more complex hardware removal is performed in an outpatient setting, such as removing a buried screw from a previous medial malleolar fracture repair, then CPT® 20680 is appropriate.
*CPT® 20670 includes the words "separate procedure" and thus cannot be submitted as part of another procedure performed at the same anatomical site. Providers should also know the number of units of these codes submitted should relate to the number of anatomical sites addressed. For instance, removal of a buried plate with four screws through one incision would be submitted as one unit of service.
When choosing wound debridement CPT® codes (CPT 11042–11047), the code is selected based on the deepest depth of tissue removed and the surface area of the wound. The deepest depth of tissue removed may not necessarily be the deepest depth of the wound. Learn more about debridement codes and get more guidance with the APMA Coding Resource Center. 2024 CPT® Professional, p. 83
CPT® 11305–Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less.
Page 88 of the 2024 CPT Professional book explains that use of this code is reserved for sharp removal of epidermal and dermal lesions. The CPT book also states this sharp removal may be performed by transverse incision or horizontal slicing. When using this code, it is important to differentiate between “removal” and “paring.” This code is not intended to represent shaving to reduce the thickness of a callus. This code is not intended to represent debridement of an ulcer.
Sharpen your coding prowess with coding pearls. 11755—Biopsy of nail unit (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure). The AMA CPT Editorial Panel states this code is not intended to be reported when obtaining nail clippings or nail bed scrapings for purposes of performing a fungal culture, KOH preparation, stain or test, or PAS stain. Use of this code typically represents obtaining a through-and-through portion of nail plate and nail bed or a sampling of the proximal nail fold and nail matrix. There is no CPT code to represent obtaining a sample of nail clippings and sublingual debris to be sent for pathologic / microbiologic evaluation.
Reference: Page 4, December 2002 CPT Assistant Newsletter
If a partial or complete nail avulsion is performed on more than one toe at the same encounter, the second avulsion is represented by CPT® 11732 (Avulsion of nail plate, partial or complete, simple; each additional nail plate) added to CPT® 11730. As CPT 11732 is an “add-on” code, no 59, 51, or X- Modifier should be used in this scenario. Anatomic Modifiers (TA-T9) should be used.