Coding Corner Issue 3
CPT® 11755 - Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)
This CPT code is often used incorrectly. Fortunately, clarity is provided in the form of a CPT Assistant article published in December 2002. The article references three procedures that warrant the use of CPT 11755. The first involves placing a small punch through the nail plate and into the nail bed. The second technique listed in the article involves removal of the nail plate, a longitudinal incision over the affected area, removal of the specimen, and suture closure. The final example given in the article is biopsy of the nail matrix. This is described in the article as short longitudinal incisions made on either side of the proximal nail fold in line with the lateral nail folds and elevation of this tissue off the proximal nail plate. A portion of that tissue is then removed to allow access to the nail matrix from which a specimen is removed using a punch or a scalpel. This final example also describes suture closure.
CPT 11755 should not be used when clipping a piece of distal nail plate and/or removing subungual debris. The CPT Assistant article referenced above gives three examples of when CPT 11755 may be used.
Author: Dr. Jeffrey Lehrman, DPM, FASPS, MAPWCA, CPC is the Orpyx Medical Director. He is a podiatrist, a Certified Professional Coder, and Certified Professional Medical Auditor. He is in private practice in Colorado and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance, and documentation.
Reference: CPT Assistant December 2002 “Nails”
Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2021 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). CPT codes and their descriptions do not reflect or guarantee coverage or payment. The existence of a CPT code does not guarantee payment for the service it describes. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to that payer. Orpyx does not claim responsibility for any consequences or liability attributable to the use of any information, guidance, or advice contained in this email. Only providers are responsible for their coding choices.
