CPT code 11765 is for the excision of a nail fold on the toe, a procedure often performed to treat ingrown toenails or infections.
CPT code 11765 is used to describe the surgical procedure for the excision of a nail fold on a toe. This involves the removal of a portion of the skin and tissue surrounding the toenail, often to treat conditions such as ingrown toenails or infections. The procedure aims to alleviate pain, prevent further complications, and promote proper nail growth.
For CPT code 11765, "Excision of nail fold toe," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11765, which involves the excision of the nail fold toe, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 11765.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 11765. Identify discrepancies by individual payer and take control of your revenue cycle. Schedule a demo today to see how RevFind can optimize your financial outcomes.
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
