SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Surgical Treatment of Nails

A59028

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59028
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Surgical Treatment of Nails
Article Type
Billing and Coding
Original Effective Date
03/05/2023
Revision Effective Date
01/21/2024
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §20.9 National Correct Coding Initiative (NCCI)

Article Guidance

Article Text

The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for Surgical Treatment of Nails L39258.

Coding Guidelines

When billing for non-covered services, use the appropriate modifier.

When CPT® code 11730, 11732 or 11750 is reported, it represents all services performed on that nail for that date of service (DOS). When lateral and medial sides of a nail are involved, do not report a separate code for each border.

Reporting CPT® codes 11730 or 11732 (avulsion) with CPT® code 11750 (excision) and/or 11765 (wedge resection) for the same digit on the same DOS is not correct coding.

Reporting CPT® code 11750 (excision) with CPT® code 11765 (wedge resection) for the same digit on the same DOS is not correct coding.

Reporting CPT® code 11765 for the removal of a small piece of the skin and/or the nail without local anesthesia is not correct coding.

If CPT® procedure codes 11730, 11750, or 11765 are performed on different nails, report the procedure performed with 1 unit of service (UOS) and append with the appropriate identifying digit modifiers.

For every subsequent avulsion, CPT® code 11732 is reported as the add-on code with 1 UOS and the appropriate identifying digit modifier appended.

CPT® codes 11730 and 11732 for nail avulsion will be denied if billed for the same finger less than 16 weeks or the same toe less than 32 weeks) following a previous avulsion.

For a medically reasonable and necessary repeat nail avulsion of the same toenail or fingernail performed more often than every 32 weeks (8 months) for toenails or every 16 weeks (4 months) for fingernails, report modifier KX (Requirements specified in the medical record have been met). The medical record documentation must be specific as to the indication, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated.

For a medically reasonable and necessary repeat nail excision on the same finger or toe, report modifier KX (Requirements specified in the medical record have been met). The medical record documentation must be specific as to the indication, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

(20 Codes)
Group 1 Paragraph

For reimbursement to be considered, claims must include the nail on which the procedure is performed using 1 of the modifiers listed below to identify the digit.

Group 1 Codes
Code Description
F1 LEFT HAND, SECOND DIGIT
F2 LEFT HAND, THIRD DIGIT
F3 LEFT HAND, FOURTH DIGIT
F4 LEFT HAND, FIFTH DIGIT
F5 RIGHT HAND, THUMB
F6 RIGHT HAND, SECOND DIGIT
F7 RIGHT HAND, THIRD DIGIT
F8 RIGHT HAND, FOURTH DIGIT
F9 RIGHT HAND, FIFTH DIGIT
FA LEFT HAND, THUMB
T1 LEFT FOOT, SECOND DIGIT
T2 LEFT FOOT, THIRD DIGIT
T3 LEFT FOOT, FOURTH DIGIT
T4 LEFT FOOT, FIFTH DIGIT
T5 RIGHT FOOT, GREAT TOE
T6 RIGHT FOOT, SECOND DIGIT
T7 RIGHT FOOT, THIRD DIGIT
T8 RIGHT FOOT, FOURTH DIGIT
T9 RIGHT FOOT, FIFTH DIGIT
TA LEFT FOOT, GREAT TOE
N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(392 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Group 1 Codes
Code Description
B35.1 Tinea unguium
I96 Gangrene, not elsewhere classified
L03.011 Cellulitis of right finger
L03.012 Cellulitis of left finger
L03.031 Cellulitis of right toe
L03.032 Cellulitis of left toe
L40.0 Psoriasis vulgaris
L40.1 Generalized pustular psoriasis
L40.2 Acrodermatitis continua
L40.3 Pustulosis palmaris et plantaris
L40.4 Guttate psoriasis
L40.8 Other psoriasis
L43.0 Hypertrophic lichen planus
L43.3 Subacute (active) lichen planus
L43.8 Other lichen planus
L60.0 Ingrowing nail
L60.1 Onycholysis
L60.2 Onychogryphosis
L60.3 Nail dystrophy
L60.4 Beau's lines
L60.5 Yellow nail syndrome
L60.8* Other nail disorders
Q84.3 Anonychia
Q84.4 Congenital leukonychia
Q84.5 Enlarged and hypertrophic nails
Q84.6 Other congenital malformations of nails
S60.111A Contusion of right thumb with damage to nail, initial encounter
S60.111D Contusion of right thumb with damage to nail, subsequent encounter
S60.111S Contusion of right thumb with damage to nail, sequela
S60.112A Contusion of left thumb with damage to nail, initial encounter
S60.112D Contusion of left thumb with damage to nail, subsequent encounter
S60.112S Contusion of left thumb with damage to nail, sequela
S60.121A Contusion of right index finger with damage to nail, initial encounter
S60.121D Contusion of right index finger with damage to nail, subsequent encounter
S60.121S Contusion of right index finger with damage to nail, sequela
S60.122A Contusion of left index finger with damage to nail, initial encounter
S60.122D Contusion of left index finger with damage to nail, subsequent encounter
S60.122S Contusion of left index finger with damage to nail, sequela
S60.131A Contusion of right middle finger with damage to nail, initial encounter
S60.131D Contusion of right middle finger with damage to nail, subsequent encounter
S60.131S Contusion of right middle finger with damage to nail, sequela
S60.132A Contusion of left middle finger with damage to nail, initial encounter
S60.132D Contusion of left middle finger with damage to nail, subsequent encounter
S60.132S Contusion of left middle finger with damage to nail, sequela
S60.141A Contusion of right ring finger with damage to nail, initial encounter
S60.141D Contusion of right ring finger with damage to nail, subsequent encounter
S60.141S Contusion of right ring finger with damage to nail, sequela
S60.142A Contusion of left ring finger with damage to nail, initial encounter
S60.142D Contusion of left ring finger with damage to nail, subsequent encounter
S60.142S Contusion of left ring finger with damage to nail, sequela
S60.151A Contusion of right little finger with damage to nail, initial encounter
S60.151D Contusion of right little finger with damage to nail, subsequent encounter
S60.151S Contusion of right little finger with damage to nail, sequela
S60.152A Contusion of left little finger with damage to nail, initial encounter
S60.152D Contusion of left little finger with damage to nail, subsequent encounter
S60.152S Contusion of left little finger with damage to nail, sequela
S61.111A Laceration without foreign body of right thumb with damage to nail, initial encounter
S61.111D Laceration without foreign body of right thumb with damage to nail, subsequent encounter
S61.111S Laceration without foreign body of right thumb with damage to nail, sequela
S61.112A Laceration without foreign body of left thumb with damage to nail, initial encounter
S61.112D Laceration without foreign body of left thumb with damage to nail, subsequent encounter
S61.112S Laceration without foreign body of left thumb with damage to nail, sequela
S61.121A Laceration with foreign body of right thumb with damage to nail, initial encounter
S61.121D Laceration with foreign body of right thumb with damage to nail, subsequent encounter
S61.121S Laceration with foreign body of right thumb with damage to nail, sequela
S61.122A Laceration with foreign body of left thumb with damage to nail, initial encounter
S61.122D Laceration with foreign body of left thumb with damage to nail, subsequent encounter
S61.122S Laceration with foreign body of left thumb with damage to nail, sequela
S61.131A Puncture wound without foreign body of right thumb with damage to nail, initial encounter
S61.131D Puncture wound without foreign body of right thumb with damage to nail, subsequent encounter
S61.131S Puncture wound without foreign body of right thumb with damage to nail, sequela
S61.132A Puncture wound without foreign body of left thumb with damage to nail, initial encounter
S61.132D Puncture wound without foreign body of left thumb with damage to nail, subsequent encounter
S61.132S Puncture wound without foreign body of left thumb with damage to nail, sequela
S61.141A Puncture wound with foreign body of right thumb with damage to nail, initial encounter
S61.141D Puncture wound with foreign body of right thumb with damage to nail, subsequent encounter
S61.141S Puncture wound with foreign body of right thumb with damage to nail, sequela
S61.142A Puncture wound with foreign body of left thumb with damage to nail, initial encounter
S61.142D Puncture wound with foreign body of left thumb with damage to nail, subsequent encounter
S61.142S Puncture wound with foreign body of left thumb with damage to nail, sequela
S61.151A Open bite of right thumb with damage to nail, initial encounter
S61.151D Open bite of right thumb with damage to nail, subsequent encounter
S61.151S Open bite of right thumb with damage to nail, sequela
S61.152A Open bite of left thumb with damage to nail, initial encounter
S61.152D Open bite of left thumb with damage to nail, subsequent encounter
S61.152S Open bite of left thumb with damage to nail, sequela
S61.310A Laceration without foreign body of right index finger with damage to nail, initial encounter
S61.310D Laceration without foreign body of right index finger with damage to nail, subsequent encounter
S61.310S Laceration without foreign body of right index finger with damage to nail, sequela
S61.311A Laceration without foreign body of left index finger with damage to nail, initial encounter
S61.311D Laceration without foreign body of left index finger with damage to nail, subsequent encounter
S61.311S Laceration without foreign body of left index finger with damage to nail, sequela
S61.312A Laceration without foreign body of right middle finger with damage to nail, initial encounter
S61.312D Laceration without foreign body of right middle finger with damage to nail, subsequent encounter
S61.312S Laceration without foreign body of right middle finger with damage to nail, sequela
S61.313A Laceration without foreign body of left middle finger with damage to nail, initial encounter
S61.313D Laceration without foreign body of left middle finger with damage to nail, subsequent encounter
S61.313S Laceration without foreign body of left middle finger with damage to nail, sequela
S61.314A Laceration without foreign body of right ring finger with damage to nail, initial encounter
S61.314D Laceration without foreign body of right ring finger with damage to nail, subsequent encounter
S61.314S Laceration without foreign body of right ring finger with damage to nail, sequela
S61.315A Laceration without foreign body of left ring finger with damage to nail, initial encounter
S61.315D Laceration without foreign body of left ring finger with damage to nail, subsequent encounter
S61.315S Laceration without foreign body of left ring finger with damage to nail, sequela
S61.316A Laceration without foreign body of right little finger with damage to nail, initial encounter
S61.316D Laceration without foreign body of right little finger with damage to nail, subsequent encounter
S61.316S Laceration without foreign body of right little finger with damage to nail, sequela
S61.317A Laceration without foreign body of left little finger with damage to nail, initial encounter
S61.317D Laceration without foreign body of left little finger with damage to nail, subsequent encounter
S61.317S Laceration without foreign body of left little finger with damage to nail, sequela
S61.320A Laceration with foreign body of right index finger with damage to nail, initial encounter
S61.320D Laceration with foreign body of right index finger with damage to nail, subsequent encounter
S61.320S Laceration with foreign body of right index finger with damage to nail, sequela
S61.321A Laceration with foreign body of left index finger with damage to nail, initial encounter
S61.321D Laceration with foreign body of left index finger with damage to nail, subsequent encounter
S61.321S Laceration with foreign body of left index finger with damage to nail, sequela
S61.322A Laceration with foreign body of right middle finger with damage to nail, initial encounter
S61.322D Laceration with foreign body of right middle finger with damage to nail, subsequent encounter
S61.322S Laceration with foreign body of right middle finger with damage to nail, sequela
S61.323A Laceration with foreign body of left middle finger with damage to nail, initial encounter
S61.323D Laceration with foreign body of left middle finger with damage to nail, subsequent encounter
S61.323S Laceration with foreign body of left middle finger with damage to nail, sequela
S61.324A Laceration with foreign body of right ring finger with damage to nail, initial encounter
S61.324D Laceration with foreign body of right ring finger with damage to nail, subsequent encounter
S61.324S Laceration with foreign body of right ring finger with damage to nail, sequela
S61.325A Laceration with foreign body of left ring finger with damage to nail, initial encounter
S61.325D Laceration with foreign body of left ring finger with damage to nail, subsequent encounter
S61.325S Laceration with foreign body of left ring finger with damage to nail, sequela
S61.326A Laceration with foreign body of right little finger with damage to nail, initial encounter
S61.326D Laceration with foreign body of right little finger with damage to nail, subsequent encounter
S61.326S Laceration with foreign body of right little finger with damage to nail, sequela
S61.327A Laceration with foreign body of left little finger with damage to nail, initial encounter
S61.327D Laceration with foreign body of left little finger with damage to nail, subsequent encounter
S61.327S Laceration with foreign body of left little finger with damage to nail, sequela
S61.330A Puncture wound without foreign body of right index finger with damage to nail, initial encounter
S61.330D Puncture wound without foreign body of right index finger with damage to nail, subsequent encounter
S61.330S Puncture wound without foreign body of right index finger with damage to nail, sequela
S61.331A Puncture wound without foreign body of left index finger with damage to nail, initial encounter
S61.331D Puncture wound without foreign body of left index finger with damage to nail, subsequent encounter
S61.331S Puncture wound without foreign body of left index finger with damage to nail, sequela
S61.332A Puncture wound without foreign body of right middle finger with damage to nail, initial encounter
S61.332D Puncture wound without foreign body of right middle finger with damage to nail, subsequent encounter
S61.332S Puncture wound without foreign body of right middle finger with damage to nail, sequela
S61.333A Puncture wound without foreign body of left middle finger with damage to nail, initial encounter
S61.333D Puncture wound without foreign body of left middle finger with damage to nail, subsequent encounter
S61.333S Puncture wound without foreign body of left middle finger with damage to nail, sequela
S61.334A Puncture wound without foreign body of right ring finger with damage to nail, initial encounter
S61.334D Puncture wound without foreign body of right ring finger with damage to nail, subsequent encounter
S61.334S Puncture wound without foreign body of right ring finger with damage to nail, sequela
S61.335A Puncture wound without foreign body of left ring finger with damage to nail, initial encounter
S61.335D Puncture wound without foreign body of left ring finger with damage to nail, subsequent encounter
S61.335S Puncture wound without foreign body of left ring finger with damage to nail, sequela
S61.336A Puncture wound without foreign body of right little finger with damage to nail, initial encounter
S61.336D Puncture wound without foreign body of right little finger with damage to nail, subsequent encounter
S61.336S Puncture wound without foreign body of right little finger with damage to nail, sequela
S61.337A Puncture wound without foreign body of left little finger with damage to nail, initial encounter
S61.337D Puncture wound without foreign body of left little finger with damage to nail, subsequent encounter
S61.337S Puncture wound without foreign body of left little finger with damage to nail, sequela
S61.340A Puncture wound with foreign body of right index finger with damage to nail, initial encounter
S61.340D Puncture wound with foreign body of right index finger with damage to nail, subsequent encounter
S61.340S Puncture wound with foreign body of right index finger with damage to nail, sequela
S61.341A Puncture wound with foreign body of left index finger with damage to nail, initial encounter
S61.341D Puncture wound with foreign body of left index finger with damage to nail, subsequent encounter
S61.341S Puncture wound with foreign body of left index finger with damage to nail, sequela
S61.342A Puncture wound with foreign body of right middle finger with damage to nail, initial encounter
S61.342D Puncture wound with foreign body of right middle finger with damage to nail, subsequent encounter
S61.342S Puncture wound with foreign body of right middle finger with damage to nail, sequela
S61.343A Puncture wound with foreign body of left middle finger with damage to nail, initial encounter
S61.343D Puncture wound with foreign body of left middle finger with damage to nail, subsequent encounter
S61.343S Puncture wound with foreign body of left middle finger with damage to nail, sequela
S61.344A Puncture wound with foreign body of right ring finger with damage to nail, initial encounter
S61.344D Puncture wound with foreign body of right ring finger with damage to nail, subsequent encounter
S61.344S Puncture wound with foreign body of right ring finger with damage to nail, sequela
S61.345A Puncture wound with foreign body of left ring finger with damage to nail, initial encounter
S61.345D Puncture wound with foreign body of left ring finger with damage to nail, subsequent encounter
S61.345S Puncture wound with foreign body of left ring finger with damage to nail, sequela
S61.346A Puncture wound with foreign body of right little finger with damage to nail, initial encounter
S61.346D Puncture wound with foreign body of right little finger with damage to nail, subsequent encounter
S61.346S Puncture wound with foreign body of right little finger with damage to nail, sequela
S61.347A Puncture wound with foreign body of left little finger with damage to nail, initial encounter
S61.347D Puncture wound with foreign body of left little finger with damage to nail, subsequent encounter
S61.347S Puncture wound with foreign body of left little finger with damage to nail, sequela
S61.350A Open bite of right index finger with damage to nail, initial encounter
S61.350D Open bite of right index finger with damage to nail, subsequent encounter
S61.350S Open bite of right index finger with damage to nail, sequela
S61.351A Open bite of left index finger with damage to nail, initial encounter
S61.351D Open bite of left index finger with damage to nail, subsequent encounter
S61.351S Open bite of left index finger with damage to nail, sequela
S61.352A Open bite of right middle finger with damage to nail, initial encounter
S61.352D Open bite of right middle finger with damage to nail, subsequent encounter
S61.352S Open bite of right middle finger with damage to nail, sequela
S61.353A Open bite of left middle finger with damage to nail, initial encounter
S61.353D Open bite of left middle finger with damage to nail, subsequent encounter
S61.353S Open bite of left middle finger with damage to nail, sequela
S61.354A Open bite of right ring finger with damage to nail, initial encounter
S61.354D Open bite of right ring finger with damage to nail, subsequent encounter
S61.354S Open bite of right ring finger with damage to nail, sequela
S61.355A Open bite of left ring finger with damage to nail, initial encounter
S61.355D Open bite of left ring finger with damage to nail, subsequent encounter
S61.355S Open bite of left ring finger with damage to nail, sequela
S61.356A Open bite of right little finger with damage to nail, initial encounter
S61.356D Open bite of right little finger with damage to nail, subsequent encounter
S61.356S Open bite of right little finger with damage to nail, sequela
S61.357A Open bite of left little finger with damage to nail, initial encounter
S61.357D Open bite of left little finger with damage to nail, subsequent encounter
S61.357S Open bite of left little finger with damage to nail, sequela
S67.01XA Crushing injury of right thumb, initial encounter
S67.01XD Crushing injury of right thumb, subsequent encounter
S67.01XS Crushing injury of right thumb, sequela
S67.02XA Crushing injury of left thumb, initial encounter
S67.02XD Crushing injury of left thumb, subsequent encounter
S67.02XS Crushing injury of left thumb, sequela
S67.190A Crushing injury of right index finger, initial encounter
S67.190D Crushing injury of right index finger, subsequent encounter
S67.190S Crushing injury of right index finger, sequela
S67.191A Crushing injury of left index finger, initial encounter
S67.191D Crushing injury of left index finger, subsequent encounter
S67.191S Crushing injury of left index finger, sequela
S67.192A Crushing injury of right middle finger, initial encounter
S67.192D Crushing injury of right middle finger, subsequent encounter
S67.192S Crushing injury of right middle finger, sequela
S67.193A Crushing injury of left middle finger, initial encounter
S67.193D Crushing injury of left middle finger, subsequent encounter
S67.193S Crushing injury of left middle finger, sequela
S67.194A Crushing injury of right ring finger, initial encounter
S67.194D Crushing injury of right ring finger, subsequent encounter
S67.194S Crushing injury of right ring finger, sequela
S67.195A Crushing injury of left ring finger, initial encounter
S67.195D Crushing injury of left ring finger, subsequent encounter
S67.195S Crushing injury of left ring finger, sequela
S67.196A Crushing injury of right little finger, initial encounter
S67.196D Crushing injury of right little finger, subsequent encounter
S67.196S Crushing injury of right little finger, sequela
S67.197A Crushing injury of left little finger, initial encounter
S67.197D Crushing injury of left little finger, subsequent encounter
S67.197S Crushing injury of left little finger, sequela
S90.211A Contusion of right great toe with damage to nail, initial encounter
S90.211D Contusion of right great toe with damage to nail, subsequent encounter
S90.211S Contusion of right great toe with damage to nail, sequela
S90.212A Contusion of left great toe with damage to nail, initial encounter
S90.212D Contusion of left great toe with damage to nail, subsequent encounter
S90.212S Contusion of left great toe with damage to nail, sequela
S90.221A Contusion of right lesser toe(s) with damage to nail, initial encounter
S90.221D Contusion of right lesser toe(s) with damage to nail, subsequent encounter
S90.221S Contusion of right lesser toe(s) with damage to nail, sequela
S90.222A Contusion of left lesser toe(s) with damage to nail, initial encounter
S90.222D Contusion of left lesser toe(s) with damage to nail, subsequent encounter
S90.222S Contusion of left lesser toe(s) with damage to nail, sequela
S91.211A Laceration without foreign body of right great toe with damage to nail, initial encounter
S91.211D Laceration without foreign body of right great toe with damage to nail, subsequent encounter
S91.211S Laceration without foreign body of right great toe with damage to nail, sequela
S91.212A Laceration without foreign body of left great toe with damage to nail, initial encounter
S91.212D Laceration without foreign body of left great toe with damage to nail, subsequent encounter
S91.212S Laceration without foreign body of left great toe with damage to nail, sequela
S91.214A Laceration without foreign body of right lesser toe(s) with damage to nail, initial encounter
S91.214D Laceration without foreign body of right lesser toe(s) with damage to nail, subsequent encounter
S91.214S Laceration without foreign body of right lesser toe(s) with damage to nail, sequela
S91.215A Laceration without foreign body of left lesser toe(s) with damage to nail, initial encounter
S91.215D Laceration without foreign body of left lesser toe(s) with damage to nail, subsequent encounter
S91.215S Laceration without foreign body of left lesser toe(s) with damage to nail, sequela
S91.221A Laceration with foreign body of right great toe with damage to nail, initial encounter
S91.221D Laceration with foreign body of right great toe with damage to nail, subsequent encounter
S91.221S Laceration with foreign body of right great toe with damage to nail, sequela
S91.222A Laceration with foreign body of left great toe with damage to nail, initial encounter
S91.222D Laceration with foreign body of left great toe with damage to nail, subsequent encounter
S91.222S Laceration with foreign body of left great toe with damage to nail, sequela
S91.224A Laceration with foreign body of right lesser toe(s) with damage to nail, initial encounter
S91.224D Laceration with foreign body of right lesser toe(s) with damage to nail, subsequent encounter
S91.224S Laceration with foreign body of right lesser toe(s) with damage to nail, sequela
S91.225A Laceration with foreign body of left lesser toe(s) with damage to nail, initial encounter
S91.225D Laceration with foreign body of left lesser toe(s) with damage to nail, subsequent encounter
S91.225S Laceration with foreign body of left lesser toe(s) with damage to nail, sequela
S91.231A Puncture wound without foreign body of right great toe with damage to nail, initial encounter
S91.231D Puncture wound without foreign body of right great toe with damage to nail, subsequent encounter
S91.231S Puncture wound without foreign body of right great toe with damage to nail, sequela
S91.232A Puncture wound without foreign body of left great toe with damage to nail, initial encounter
S91.232D Puncture wound without foreign body of left great toe with damage to nail, subsequent encounter
S91.232S Puncture wound without foreign body of left great toe with damage to nail, sequela
S91.234A Puncture wound without foreign body of right lesser toe(s) with damage to nail, initial encounter
S91.234D Puncture wound without foreign body of right lesser toe(s) with damage to nail, subsequent encounter
S91.234S Puncture wound without foreign body of right lesser toe(s) with damage to nail, sequela
S91.235A Puncture wound without foreign body of left lesser toe(s) with damage to nail, initial encounter
S91.235D Puncture wound without foreign body of left lesser toe(s) with damage to nail, subsequent encounter
S91.235S Puncture wound without foreign body of left lesser toe(s) with damage to nail, sequela
S91.241A Puncture wound with foreign body of right great toe with damage to nail, initial encounter
S91.241D Puncture wound with foreign body of right great toe with damage to nail, subsequent encounter
S91.241S Puncture wound with foreign body of right great toe with damage to nail, sequela
S91.242A Puncture wound with foreign body of left great toe with damage to nail, initial encounter
S91.242D Puncture wound with foreign body of left great toe with damage to nail, subsequent encounter
S91.242S Puncture wound with foreign body of left great toe with damage to nail, sequela
S91.244A Puncture wound with foreign body of right lesser toe(s) with damage to nail, initial encounter
S91.244D Puncture wound with foreign body of right lesser toe(s) with damage to nail, subsequent encounter
S91.244S Puncture wound with foreign body of right lesser toe(s) with damage to nail, sequela
S91.245A Puncture wound with foreign body of left lesser toe(s) with damage to nail, initial encounter
S91.245D Puncture wound with foreign body of left lesser toe(s) with damage to nail, subsequent encounter
S91.245S Puncture wound with foreign body of left lesser toe(s) with damage to nail, sequela
S91.251A Open bite of right great toe with damage to nail, initial encounter
S91.251D Open bite of right great toe with damage to nail, subsequent encounter
S91.251S Open bite of right great toe with damage to nail, sequela
S91.252A Open bite of left great toe with damage to nail, initial encounter
S91.252D Open bite of left great toe with damage to nail, subsequent encounter
S91.252S Open bite of left great toe with damage to nail, sequela
S91.254A Open bite of right lesser toe(s) with damage to nail, initial encounter
S91.254D Open bite of right lesser toe(s) with damage to nail, subsequent encounter
S91.254S Open bite of right lesser toe(s) with damage to nail, sequela
S91.255A Open bite of left lesser toe(s) with damage to nail, initial encounter
S91.255D Open bite of left lesser toe(s) with damage to nail, subsequent encounter
S91.255S Open bite of left lesser toe(s) with damage to nail, sequela
S97.111A Crushing injury of right great toe, initial encounter
S97.111D Crushing injury of right great toe, subsequent encounter
S97.111S Crushing injury of right great toe, sequela
S97.112A Crushing injury of left great toe, initial encounter
S97.112D Crushing injury of left great toe, subsequent encounter
S97.112S Crushing injury of left great toe, sequela
S97.121A Crushing injury of right lesser toe(s), initial encounter
S97.121D Crushing injury of right lesser toe(s), subsequent encounter
S97.121S Crushing injury of right lesser toe(s), sequela
S97.122A Crushing injury of left lesser toe(s), initial encounter
S97.122D Crushing injury of left lesser toe(s), subsequent encounter
S97.122S Crushing injury of left lesser toe(s), sequela
T23.311A Burn of third degree of right thumb (nail), initial encounter
T23.311D Burn of third degree of right thumb (nail), subsequent encounter
T23.311S Burn of third degree of right thumb (nail), sequela
T23.312A Burn of third degree of left thumb (nail), initial encounter
T23.312D Burn of third degree of left thumb (nail), subsequent encounter
T23.312S Burn of third degree of left thumb (nail), sequela
T23.321A Burn of third degree of single right finger (nail) except thumb, initial encounter
T23.321D Burn of third degree of single right finger (nail) except thumb, subsequent encounter
T23.321S Burn of third degree of single right finger (nail) except thumb, sequela
T23.322A Burn of third degree of single left finger (nail) except thumb, initial encounter
T23.322D Burn of third degree of single left finger (nail) except thumb, subsequent encounter
T23.322S Burn of third degree of single left finger (nail) except thumb, sequela
T23.331A Burn of third degree of multiple right fingers (nail), not including thumb, initial encounter
T23.331D Burn of third degree of multiple right fingers (nail), not including thumb, subsequent encounter
T23.331S Burn of third degree of multiple right fingers (nail), not including thumb, sequela
T23.332A Burn of third degree of multiple left fingers (nail), not including thumb, initial encounter
T23.332D Burn of third degree of multiple left fingers (nail), not including thumb, subsequent encounter
T23.332S Burn of third degree of multiple left fingers (nail), not including thumb, sequela
T23.341A Burn of third degree of multiple right fingers (nail), including thumb, initial encounter
T23.341D Burn of third degree of multiple right fingers (nail), including thumb, subsequent encounter
T23.341S Burn of third degree of multiple right fingers (nail), including thumb, sequela
T23.342A Burn of third degree of multiple left fingers (nail), including thumb, initial encounter
T23.342D Burn of third degree of multiple left fingers (nail), including thumb, subsequent encounter
T23.342S Burn of third degree of multiple left fingers (nail), including thumb, sequela
T23.711A Corrosion of third degree of right thumb (nail), initial encounter
T23.711D Corrosion of third degree of right thumb (nail), subsequent encounter
T23.711S Corrosion of third degree of right thumb (nail), sequela
T23.712A Corrosion of third degree of left thumb (nail), initial encounter
T23.712D Corrosion of third degree of left thumb (nail), subsequent encounter
T23.712S Corrosion of third degree of left thumb (nail), sequela
T23.721A Corrosion of third degree of single right finger (nail) except thumb, initial encounter
T23.721D Corrosion of third degree of single right finger (nail) except thumb, subsequent encounter
T23.721S Corrosion of third degree of single right finger (nail) except thumb, sequela
T23.722A Corrosion of third degree of single left finger (nail) except thumb, initial encounter
T23.722D Corrosion of third degree of single left finger (nail) except thumb, subsequent encounter
T23.722S Corrosion of third degree of single left finger (nail) except thumb, sequela
T23.731A Corrosion of third degree of multiple right fingers (nail), not including thumb, initial encounter
T23.731D Corrosion of third degree of multiple right fingers (nail), not including thumb, subsequent encounter
T23.731S Corrosion of third degree of multiple right fingers (nail), not including thumb, sequela
T23.732A Corrosion of third degree of multiple left fingers (nail), not including thumb, initial encounter
T23.732D Corrosion of third degree of multiple left fingers (nail), not including thumb, subsequent encounter
T23.732S Corrosion of third degree of multiple left fingers (nail), not including thumb, sequela
T23.741A Corrosion of third degree of multiple right fingers (nail), including thumb, initial encounter
T23.741D Corrosion of third degree of multiple right fingers (nail), including thumb, subsequent encounter
T23.741S Corrosion of third degree of multiple right fingers (nail), including thumb, sequela
T23.742A Corrosion of third degree of multiple left fingers (nail), including thumb, initial encounter
T23.742D Corrosion of third degree of multiple left fingers (nail), including thumb, subsequent encounter
T23.742S Corrosion of third degree of multiple left fingers (nail), including thumb, sequela
T25.331A Burn of third degree of right toe(s) (nail), initial encounter
T25.331D Burn of third degree of right toe(s) (nail), subsequent encounter
T25.331S Burn of third degree of right toe(s) (nail), sequela
T25.332A Burn of third degree of left toe(s) (nail), initial encounter
T25.332D Burn of third degree of left toe(s) (nail), subsequent encounter
T25.332S Burn of third degree of left toe(s) (nail), sequela
T25.731A Corrosion of third degree of right toe(s) (nail), initial encounter
T25.731D Corrosion of third degree of right toe(s) (nail), subsequent encounter
T25.731S Corrosion of third degree of right toe(s) (nail), sequela
T25.732A Corrosion of third degree of left toe(s) (nail), initial encounter
T25.732D Corrosion of third degree of left toe(s) (nail), subsequent encounter
T25.732S Corrosion of third degree of left toe(s) (nail), sequela
T33.531A Superficial frostbite of right finger(s), initial encounter
T33.531D Superficial frostbite of right finger(s), subsequent encounter
T33.531S Superficial frostbite of right finger(s), sequela
T33.532A Superficial frostbite of left finger(s), initial encounter
T33.532D Superficial frostbite of left finger(s), subsequent encounter
T33.532S Superficial frostbite of left finger(s), sequela
T33.831A Superficial frostbite of right toe(s), initial encounter
T33.831D Superficial frostbite of right toe(s), subsequent encounter
T33.831S Superficial frostbite of right toe(s), sequela
T33.832A Superficial frostbite of left toe(s), initial encounter
T33.832D Superficial frostbite of left toe(s), subsequent encounter
T33.832S Superficial frostbite of left toe(s), sequela
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

* Note: Report ICD-10 code L60.8 for the indication of subungual abscess, subungual tumor, subungual hematoma, or melanoma.

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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/21/2024 R1

Under Article Text subsection Coding Guidelines revised verbiage in 9th paragraph to read “For a medically reasonable and necessary repeat nail avulsion of the same toenail or fingernail performed more often than every 32 weeks (8 months) for toenails or every 16 weeks (4 months) for fingernails, report modifier KX (Requirements specified in the medical record have been met)” and revised verbiage in 10th paragraph to read “For a medically reasonable and necessary repeat nail excision on the same finger or toe, report modifier KX (Requirements specified in the medical record have been met). The medical record documentation must be specific as to the indication, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated.”

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L39258 - Surgical Treatment of Nails
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/12/2023 01/21/2024 - N/A Currently in Effect View
12/01/2023 01/21/2024 - N/A Superseded You are here
01/13/2023 03/05/2023 - 01/20/2024 Superseded View

Keywords

  • onychocryptosis
  • ingrown nail
  • onychomycosis
  • onychogryphosis
  • subungual hematoma
  • onychauxis
  • lichen planus
  • psoriasis