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11755

David Posted Tue 02nd of December, 2014 12:57:01 PM

how to bill 11755 nail bed & lateral nail fold

SuperCoder Answered Tue 02nd of December, 2014 13:42:54 PM

Thank you for your question.

Your question is very vague and we would need more detail to appropriately answer this question. I have the CPT description of 11755 below as well as the clinical responsibility for this code.

11755-Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)

This procedural code is used when the physician biopsies the nail plate, bed, hyponychium, proximal nail folds, or lateral nail folds. Each one is a separate procedure.

Clinical Responsibility

When the physician performs a nail unit biopsy, he cuts through the nail plate, biopsies the nail bed, and then sutures the wound closed so it can heal properly.

Terminology

The nail plate is what we commonly call the nail, or the hard, translucent plate. The nail bed is the connective tissue directly under the nail. The nail matrix is the nail plate's proximal end underlying the proximal nail fold. The hyponychium is the place where the skin attaches to the nail at the finger or toe's distal end, forming the distal groove.

David Posted Fri 05th of December, 2014 10:14:45 AM

The procedure performed was 11755 - 2 units both Left Lateral Great Toenail ( Modifier TA)
One was punch and one was shave same toe although different area of the great toe,
left lateral great toenail and left medial nail bed of the left great toe.
Previously submitted the claim as 11755 with 2 units this claim was denied stating we should rebill correctly.
Would sending the claim :
11755 TA
11755 TA 59 @ 1 unit each be the accurate way to bill this claim.
Thank you for your assistance

SuperCoder Answered Mon 08th of December, 2014 08:06:48 AM

Thank you.

Your resubmission is appropriate:

11755 TA
11755 TA 59 @ 1 unit each be the accurate way to bill this claim. - See more at: https://www.supercoder.com/my-ask-an-expert/topic/11755-1#sthash.OPtl5T8a.dpuf

When billing 2 units of the same code, you would want to use modifier 59 as appropriate. You may need to submit supporting documentation depending on the payer.

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