“All the nails were trimmed in length with a sterile nail nipper. The leading edges were debrided with the nail bur and electric podiatry drill. The debris under the edges of the great toenails was derided with the sterile curette. Is this nail trimming (CPT 11719) since we DID NOT debride the entire nail (just edges and under toe) or can we bill as CPT 11721?”
Let’s first look at the four procedure codes involved when it comes to debriding or trimming of the toenails.
CPT 11720 Debridement of nail(s) by any method(s); 1 to 5
CPT 11721 Debridement of nail(s) by any method(s); 6 or more
CPT 11719 Trimming of nondystrophic nails, any number
G0127 Trimming of dystrophic nails, any number
Let’s now look at the definitions.
Debridement of Toenails: Nail debridement involves the significant reduction in the thickness and length of the nail to the tolerance of the patient with the aim of allowing the patient to ambulate without pain. Simple trimming of the end of the toenails by cutting or grinding is not considered debridement.
The bottom line comes down to the type of toenail that you are addressing. Of course one must access the LCDs of their Medicare Administrative Carrier for the documentation and billing requirements (ie. Debridement of nails, Routine Foot Care). If the toenails are documented as dystrophic, the appropriate code to bill is HCPCS Level II code G0127. If the toenails are documented as non-dystrophic or essentially “normal” toenails, the appropriate code to bill is CPT code 11719. If the toenails are documented as mycotic, the appropriate CPT code to bill based upon the number of toenails that are debrided is either CPT 11720 or CPT 11721.
When you factor in all of the above information and then you read the question that was posted, assuming the criteria for “At Risk,” Routine Foot Care are met, CPT code 11719 would be the answer.
This is my opinion.
Michael G. Warshaw