Coding Guidelines
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

The debridement of nails is the removal of nail substance, partial or complete, when the presence of such structures is causing local pathology. It is a temporary reduction in the size or girth of an abnormal nail plate, short of avulsion. It is performed most commonly without anesthesia to accomplish any or all of the following objectives:(1) relief of pain; (2) treatment of infection (bacterial, fungal, and viral); (3) temporary removal of an anatomic deformity such as onychauxis (thickened nail), or certain types of onychocryptosis (ingrown nail); (4) exposure of subungual conditions for the purpose of treatment as well as diagnosis (biopsy, culture, etc); (5) as a prophylactic measure to prevent further problems, such as a subungual ulceration in an insensate patient with onychauxis.

The debridement of nails is addressed in LCD L27487 and should not be billed using any of the codes identified in the "CPT/HCPCS Codes" section of this policy.

The description of CPT codes 11730 and 11750 indicates partial or complete. When one of these codes is reported, it represents all services performed on that nail for that date of service. When borders of a nail are involved, do not report a separate code for each border and do not report an avulsion (11730) and an excision (11750) for the same nail.

The toe nail must be identified using one of the following modifiers in order for payment to be considered. If the modifier is not used the claim will be rejected.

• TA-Left Foot-great toe
• T1-Left Foot-2nd digit
• T2-Left Foot-3rd digit
• T3-Left Foot-4th digit
• T4-Left Foot-5th digit
• T5-Right Foot-great toe
• T6-Right Foot-2nd digit
• T7-Right Foot-3rd digit
• T8-Right Foot-4th digit
• T9-Right Foot-5th digit

Bill Type Codes

Revenue Codes