CPT code 11730 is the medical billing code for the removal of a nail plate, typically used in procedures involving nail disorders.
CPT code 11730 is used to describe the medical procedure for the removal of a nail plate. This involves the complete or partial removal of a fingernail or toenail, typically due to conditions such as fungal infections, ingrown nails, or trauma. The procedure is performed by a healthcare provider and may involve the use of local anesthesia to minimize discomfort.
For CPT code 11730 (Removal of nail plate), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same session.
3. Modifier 52 - Reduced Services: Used if the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
6. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
7. Modifier 76 - Repeat Procedure by Same Physician: Used if the procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Used if the procedure is repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11730, which involves the removal of a nail plate, is reimbursed by Medicare. Reimbursement for this procedure is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the specific reimbursement rates and coverage policies can vary depending on the region, as they are administered by the respective Medicare Administrative Contractor (MAC) for that area.
It is essential for healthcare providers to consult the MPFS and their local MAC guidelines to ensure accurate billing and reimbursement for CPT code 11730.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 11730. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
