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Prevalence and risk require targeted diagnostic testing. Onychomycosis (tinea unguium), or fungal infection of the nail, causes almost half of all nail pathologies worldwide. It is a progressive infection of the nail characterized by thickening with degrees of white to yellow-brown discoloration and separation of the nail from the nail bed. Here’s why molecular testing […]
The post Molecular Testing for Nail Fungus Yields Improved Outcomes appeared first on AAPC Knowledge Center.
Medicare has that routine foot care policy that does not allow the billing of B35.1 without an underlying condition, however, what if the fungus is in the finger nails? What diagnosis codes are you billing to report the fingers rather than the toes. Medicare has denied E/M services when we bill with B35.1. Very frustrating. Must we appeal with medical notes on all of these?
PROCEDURE Each nail border was debrided of callused nail grooves, incurvated and ingrown areas, hypertrophied cuticle and mycotic and necrotic debris. Betadine solution was used to cleanse each nail plate for antiseptic reasons after debridement was performed.
OPERATION the affected areas were prepped in the usual sterile manner. The initial approach was made with an english nail splitter using that instrument to excise the nail border spicule along the full length of the nail from the tip to the eponychial attachment., Using a freer elevator and a medium hemostat the nail border was removed. The defect was curretted clean removing all necrotic and calloused nail groove and diseased cuticle.
The pus pocket paronychia abscess was incised and drained and any visible necrotic skin and tissue removed., The surgical wound was dressed using a Betadine pad drain, antiobiotic ointment, 4×4 digital cut, kling and stockinette.
CPT: 11721, 11730, 10060
PROCEDURE Each nail border was debrided of callused nail grooves, incurvated and ingrown areas, hypertrophied cuticle and mycotic and necrotic debris. Betadine solution was used to cleanse each nail plate for antiseptic reasons after debridement was performed.
OPERATION the affected areas were prepped in the usual sterile manner. The initial approach was made with an english nail splitter using that instrument to excise the nail border spicule along the full length of the nail from the tip to the eponychial attachment., Using a freer elevator and a medium hemostat the nail border was removed. The defect was curretted clean removing all necrotic and calloused nail groove and diseased cuticle.
The pus pocket paronychia abscess was incised and drained and any visible necrotic skin and tissue removed., The surgical wound was dressed using a Betadine pad drain, antiobiotic ointment, 4×4 digital cut, kling and stockinette.
CPT: 11721, 11730, 10060
Thank you!!
Tobi C.
A physician performed a nail plate removal along with I&D drainage which he reported with 10061. I know the I&D and nail plate removal are 2 separate services, however he mentioned that he avulsed the nail cause it caused an infection therefore he also performed an I&D. My question is, can we report 17003 & 10061 with modifier 59 (Distinct procedure), or should we only report 10061. Any help would be greatly appreciated.
73 year old male who presents for an open wound of the BIG TOE, LEFt foot, which occurred 2 hrs ago, while working in his shop. Pt says that he dropped a sheet of plywood 3/8" thick 4 ft x 8 ft, and it stopped on edge on the top of his foot. He notice pain immediately, now pain is gone. He has a tear in the toe nail. Washed in cold water. There is a laceration- (deep, full thickness) located on the dorsum of the toe at the nail bed, with nail plate raised .
LENGTH/DIMENSIONS: 2 cm long
BLEEDING STATUS: controlled.
DISTAL NEURO/VASCULAR/TENDON FUNCTION: normal.
RANGE OF MOTION: normal with FROM against resistance.
PROCEDURE:
–ANESTHETIC: 2% lidocaine w/o epinephrine and digital block
–WOUND PREP: –irrigated with saline per UCC protocol. Avulsed nail plate bed was returned to nail bed beneath the cuticle. Patient tolerated this well. Bleeding controlled. NAil secured to nailbed with steri strips.
–TYPE OF CLOSURE: steri-strips interrupted
–Good closure was obtained w/ good hemostasis.
–Discharge wound care consisted of a sterile dressing.
Here is the provider’s response to our query:
This procedure is complicated, required a digital block, wound repair tools and a careful replacement of a lifted and disrupted nail base. (It is a skill that is much more complicated than "placing glue.") The most appropriate wound repair tool in this situation is the steri strip.
Thank you!:confused:
Jenn