CPT code 11750 is for the removal of a nail bed, a procedure often performed to treat chronic infections or other nail disorders.
CPT code 11750 is used to describe the medical procedure for the removal of a nail bed. This procedure is typically performed when there is a chronic or severe infection, ingrown nail, or other nail disorders that do not respond to conservative treatments. The removal of the nail bed involves surgically excising the nail matrix, which is the tissue under the nail that produces the nail itself, to prevent the nail from growing back. This can help alleviate pain, prevent further infection, and resolve other nail-related issues.
For CPT code 11750 (Removal of nail bed), the following modifiers may be applicable:
1. Modifier -50 (Bilateral Procedure): Used if the procedure is performed on both sides of the body. For example, if the nail bed removal is done on both the left and right great toes.
2. Modifier -51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the removal of the nail bed is one of several procedures performed.
3. Modifier -59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly relevant if the nail bed removal is performed in a different anatomical site or through a separate incision.
4. Modifier -RT (Right Side): Indicates that the procedure was performed on the right side of the body. For example, if the nail bed removal is done on the right great toe.
5. Modifier -LT (Left Side): Indicates that the procedure was performed on the left side of the body. For example, if the nail bed removal is done on the left great toe.
6. Modifier -GA (Waiver of Liability Statement Issued as Required by Payer Policy): Used when a waiver of liability statement is issued as required by payer policy. This modifier is relevant if there is a possibility that the procedure may not be covered by insurance.
7. Modifier -GY (Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit): Applied when the procedure is statutorily excluded from Medicare coverage or does not meet the definition of any Medicare benefit.
8. Modifier -QX (CRNA Service with Medical Direction by a Physician): Used if a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician during the procedure.
9. Modifier -QK (Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals): Applied if a physician is medically directing two, three, or four concurrent anesthesia procedures during the nail bed removal.
10. Modifier -QS (Monitored Anesthesia Care Service): Indicates that monitored anesthesia care (MAC) was provided during the procedure.
11. Modifier -GZ (Item or Service Expected to Be Denied as Not Reasonable and Necessary): Used when the provider expects that the procedure will be denied as not reasonable and necessary, and no Advance Beneficiary Notice (ABN) was issued.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11750, which involves the removal of the nail bed, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage policies and any local variations in reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 11750. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
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
