Maximize Nail Procedure Billing Accuracy – CPT Code 11750 Explained for Providers
Toenail removal may seem simple, but billing for it isn’t. The 11750 CPT code involves excision of the nail and nail matrix, and it’s essential to code it correctly to ensure proper reimbursement.
Whether you’re a podiatrist, dermatologist, or billing expert at a medical group, knowing the 11750 CPT code description, modifiers, and documentation guidelines can prevent claim denials and maximize revenue.
Here’s a first-hand breakdown from billing professionals at Express Medical Billing Services, helping healthcare providers streamline reimbursements nationwide.
What Is CPT Code 11750?
CPT code 11750 talks about to the surgical removal of part or all of the nail and its underlying atmosphere to stop future nail growth permanently. This procedure is most commonly used to treat ingrown toenails or chronically deformed nails that haven’t responded to conservative treatments.
11750 CPT Code Description & Real-Life Example
Imagine a patient comes in with a severely ingrown toenail that’s causing infection and pain. The physician numbs the area, surgically removes the nail border, and destroys the matrix using phenol to prevent regrowth. That’s a perfect example for 11750—it’s not just trimming; it’s permanent removal.
CPT Code 11750 vs. 11730 - Know the Difference
A frequent mistake we see in billing audits is confusing 11750 with 11730. Here’s the difference:
- CPT 11750 involves removing both the nail and its growth center (matrix), making it a lasting solution.
- CPT 11730 only removes the nail plate without affecting the matrix, allowing the nail to regrow over time.
Using 11730 when the matrix was actually removed can lead to underbilling and audit red flags.
Do You Essential a Modifier with 11750 CPT Code?
Yes, modifiers may be necessary, especially when treating multiple toes. Here are examples:
- Modifier 59: If 11750 is performed on two separate toes during the same visit, use modifier 59 to distinguish it as a distinct service.
- T Modifiers (T5, TA, etc.): Used for toe-specific laterality. For example:
- TA – Left great toe
- T5 – Right foot, great toe
So, if you’re billing 11750 for both big toes, use:
- 11750–TA
- 11750–59–T5
This prevents denials and accurately reflects the services rendered.
11750 CPT Code Reimbursement: What to Expect
The reimbursement for CPT 11750 can vary based on your geographic location and payer. Medicare pays approximately $90–$110, while private insurers may reimburse differently. Factors that affect reimbursement include:
- Whether the process is in-office or outpatient
- The use of appropriate modifiers
- Clear documentation of medical necessity
At Express Medical Billing, we’ve helped practices recover thousands in underpaid claims by correcting 11750 submissions.
Can You Pay CPT Code 11750 on Multiple Toes?
Yes, but the key is how you bill it.
- Bill each toe separately
- Use correct T modifiers (e.g., TA, T5)
- Apply modifier 59 for additional toes when appropriate
Always remember, each unit of 11750 represents the procedure on one toe, so don’t double up on one line. Instead, bill each toe on a separate line with its correct modifiers.
CPT Code 11750 Global Period
The 11750 CPT code takes a 10-day global period. That means follow-up visits related to the procedure within that time are not separately billable. However, unrelated services during this period may still be billed—with appropriate modifiers (like modifier 24 for unrelated E/M services).
Common ICD-10 Code with CPT Code 11750
For proper pairing, use a diagnosis code that supports the need for nail excision. Most commonly:
- L60.0 – Ingrowing nail
- L60.3 – Nail dystrophy
- B35.1 – Onychomycosis (fungal nail infection)
These codes back up medical necessity during audits.
Nail Avulsion vs. Trimming - Don’t Mix Up the Codes
- CPT Code for Toenail Trimming: 11719 – Routine care, not reimbursed by many payers unless medically necessary.
- Nail Avulsion CPT (11730): Temporary removal
- 11750 CPT Code: Permanent removal
Always distinguish the extent of the procedure in your notes to justify the use of 11750 over others.
Insights from Billing Experts
At Express Medical Billing Services, we regularly review podiatry claims and often find errors in coding toenail procedures. One client routinely billed 11730, even when a matrixectomy was done. After auditing documentation and switching to 11750 with proper modifiers, their collections jumped by over 18% in just one quarter.
Conclusion
The 11750 CPT code is more than just a number, it’s an opportunity to ensure proper reimbursement when you’ve provided medically necessary care. Use accurate modifiers, justify the need with ICD-10 codes, and document the procedure thoroughly.
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Frequently Asked Questions (FAQs)
CPT 11730 relates when the nail is elevated or taken off briefly, leaving the matrix untouched. In contrast, 11750 includes a matrixectomy, preventing nail regrowth for long-term relief.
Yes, use modifier 59 when performing on multiple toes and T modifiers like TA or T5 for toe-specific designation.
CPT code 11750 has a 10-day global period, meaning routine follow-up is included and not separately billable.
No. Toenail trimming is billed with 11719. 11750 is for surgical nail and matrix removal.
Typical ICD-10 diagnosis codes that support billing for CPT 11750 include:
- 0 – Ingrowing nail
- 3 – Nail growth abnormalities
- 1 – Fungal infection of the nails (onychomycosis)
