Podiatry Coding & Billing Alert

Question: A 78-year-old Medicare patient with type 2 diabetes and peripheral angiopathy presented to the podiatrist with complaints of thick, discolored, and painful nails on all 10 toes. The podiatrist performed a physical examination where they noted mycotic nails and absent dorsalis pedis and posterior tibial pulses bilaterally. The podiatrist reduced the length and thickness of all 10 nails.

How should we code the nail debridement?

Rhode Island Subscriber

Answer: Use 11721 (Debridement of nail(s) by any method(s); 6 or more) to report the debridement of the patient’s mycotic nails. You’ll also append modifier Q8 (Two class b findings) to 11721 to indicate that the patient has qualifying systemic conditions that warrant the nail debridement.

Medicare typically excludes nail debridement reimbursement unless the patient has a certain condition that causes changes to the nails. According to the HCPCS Level II guidelines, class B findings include the following:

• Absent posterior tibial pulse
• Absent dorsalis pedis pulse
• Advanced trophic changes which include three of the following:
  • Increase or decrease in hair growth
  • Nail thickening
  • Changes in color, texture, or reddening of the skin

The podiatrist documented missing posterior tibial and dorsalis pedis pulses in both feet and nail thickening, which is more than enough to support the Q8 modifier.

Mycotic nails, also known as onychomycoses, are nails that experience a fungal infection where the nail separates from the nail bed. As a result, the nail can thicken and become fragile, as well as change colors.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC