What is the correct CPT (Current Procedural Terminology) code for a procedure that involves the permanent removal of a nail plate and nail matrix to treat an ingrown toenail?

CPT Code for Permanent Toenail Removal with Matrix Destruction

The correct CPT code for permanent removal of a toenail along with the nail matrix is 11750, which specifically describes the procedure of nail plate removal with destruction of the nail matrix (permanent). 1

Understanding Nail Procedure CPT Codes

When coding for nail procedures, it's important to understand the distinctions between different types of nail removal procedures:

• 11730: Avulsion of nail plate, partial or complete, simple; single
• 11750: Excision of nail and nail matrix, partial or complete (e.g., ingrown or deformed nail), for permanent removal
• 11765: Wedge excision of skin of nail fold (e.g., for ingrown toenail)
• 11720: Debridement of nail(s) by any method(s); 1 to 5

Why 11750 is the Correct Code

The key elements in this case that determine the correct code are:

1. The procedure involves permanent removal of the nail
2. The procedure includes destruction of the nail matrix

CPT code 11750 specifically addresses both these elements, making it the appropriate choice for this procedure. Expert consensus on nail procedures confirms this code selection for permanent nail removal procedures that include matrix destruction 1.

Clinical Context of Ingrown Toenail Treatment

Ingrown toenails (onychocryptosis) can be treated through various approaches depending on severity:

• Conservative management for mild cases
• Surgical intervention for recurrent or severe cases

When permanent removal is indicated, the procedure typically involves:

1. Removal of the nail plate (partial or complete)
2. Destruction of the nail matrix to prevent regrowth
3. Possible excision of hypertrophic tissue if present 2, 3

Important Clinical Considerations

• Post-procedure care: Daily cleaning with lukewarm water, monitoring for infection, and appropriate dressing changes are essential for proper healing 4
• Complications: While rare, complications can include infection, hematoma, and in extreme cases, surgical site infections that could lead to more serious consequences 5
• Recovery timeline: Patients typically return to daily activities within 3 days, with complete healing in approximately 10 days 2

Common Coding Pitfalls to Avoid

• Don't confuse with 11730: This code is for simple avulsion without matrix destruction and is not intended for permanent removal
• Don't use 11765: This code is specifically for wedge excision of skin of nail fold without matrix destruction
• Don't use 11720: This code is for nail debridement only, not removal with matrix destruction

Documentation Requirements

To support the 11750 code, documentation should clearly indicate:

1. Permanent removal was performed
2. The nail matrix was destroyed
3. The specific technique used for matrix destruction (chemical, surgical, etc.)
4. The reason for permanent removal (recurrent ingrown nail, chronic infection, etc.)

By correctly coding this procedure as 11750, the podiatrist ensures proper reimbursement for the permanent removal of the nail plate along with destruction of the nail matrix.