This LCD describes conditions under which the coverage of nail avulsion/excision may be considered.
An ingrown nail is growth of the nail edge into the surrounding soft tissue that may result in pain, inflammation or infection. This condition most commonly occurs in the great toes and may require surgical management. Other conditions may also require avulsion of part or all of a nail.
The surgical treatment of ingrown nails is considered to be medically appropriate and reasonable for an ingrown toenail in the advanced stage in which the lateral nail fold bulges over the nail plate causing erythema, edema, and tenderness, and granulation of the epithelium inhibits serous drainage and precludes any chance of elevating the nail edge from the dermis of the lateral skin fold.
Treatment of simple uncomplicated or asymptomatic ingrown nail such as removal of a nail spicule may be considered to be routine foot care as are other trimming, cutting, clipping and debriding of a nail distal to the eponychium. Routine foot care is covered only when certain systemic conditions are present. (Refer to LCD: Routine Foot Care).
The following surgical procedures represent the options used to treat a complicated/symptomatic ingrown nail(s):
• Avulsion of a nail (CPT codes 11730 and 11732) involving separation and removal of the entire nail plate or a portion of nail plate (including the entire length of the nail border to and under the eponychium). A nail avulsion usually requires injected local anesthesia except in instances wherein the digit is devoid of sensation or there are other extenuating circumstances for which injectable anesthesia is not required or is medically contraindicated.
• Excision of the nail and the nail matrix (CPT code 11750) performed under local anesthesia (unless the digit is devoid of sensation, which should be documented) requiring separation and removal of the entire nail plate or a portion of nail plate (including the entire length of the nail border to and under the eponychium) followed by destruction or permanent removal of the associated nail matrix.
• Wedge excision of the nail fold hypertrophic granulation tissue with removal of the offending portion of the nail (CPT code 11765).
Nail avulsions usually offer only temporary relief for ingrown toenails. The nail often grows back to its original thickness and the offending margin again may become problematic, resulting in another nail avulsion. Therefore, a partial or complete excision of nail and nail matrix may be the preferred course of treatment for recurrent ingrown nails.
The surgical treatment of nails is also covered for the following indications:
• Subungal abscess.
• Contusion injuries of nails.
• Crushing injuries of the toes.
• Crushing injuries of the fingers.
• Paronychia.
• Complicated wounds of the toes involving nail components.
• Deformed nails that prevent wearing shoes or otherwise jeopardize the integrity of the toe.
ICD-10 Codes that Support Medical Necessity
Group 1 Codes
B35.1 Tinea unguium
I96 Gangrene, not elsewhere classified
L02.511 Cutaneous abscess of right hand
L02.512 Cutaneous abscess of left hand
L02.519 Cutaneous abscess of unspecified hand
L02.611 Cutaneous abscess of right foot
L02.612 Cutaneous abscess of left foot
L02.619 Cutaneous abscess of unspecified foot
L03.011 Cellulitis of right finger
L03.012 Cellulitis of left finger
L03.019 Cellulitis of unspecified finger
L03.021 Acute lymphangitis of right finger
L03.022 Acute lymphangitis of left finger
L03.029 Acute lymphangitis of unspecified finger
L03.031 Cellulitis of right toe
L03.032 Cellulitis of left toe
L03.039 Cellulitis of unspecified toe
L03.041 Acute lymphangitis of right toe
L03.042 Acute lymphangitis of left toe
L03.049 Acute lymphangitis of unspecified toe
L60.0 Ingrowing nail
L60.1 Onycholysis
L60.2 Onychogryphosis
L60.3 Nail dystrophy
L60.4 Beau’s lines
L60.5 Yellow nail syndrome
L60.8 Other nail disorders
L60.9 Nail disorder, unspecified
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L98.0 Pyogenic granuloma
Q84.3 Anonychia
Q84.4 Congenital leukonychia
Q84.5 Enlarged and hypertrophic nails
Q84.6 Other congenital malformations of nails
S60.111A Contusion of right thumb with damage to nail, initial encounter
S60.111D Contusion of right thumb with damage to nail, subsequent encounter
S60.111S Contusion of right thumb with damage to nail, sequela
S60.112A Contusion of left thumb with damage to nail, initial encounter
S60.112D Contusion of left thumb with damage to nail, subsequent encounter
S60.112S Contusion of left thumb with damage to nail, sequela
S60.119A Contusion of unspecified thumb with damage to nail, initial encounter
S60.119D Contusion of unspecified thumb with damage to nail, subsequent encounter
S60.119S Contusion of unspecified thumb with damage to nail, sequela
S60.121A Contusion of right index finger with damage to nail, initial encounter
S60.121D Contusion of right index finger with damage to nail, subsequent encounter
S60.121S Contusion of right index finger with damage to nail, sequela
S60.122A Contusion of left index finger with damage to nail, initial encounter
S60.122D Contusion of left index finger with damage to nail, subsequent encounter
S60.122S Contusion of left index finger with damage to nail, sequela
S60.129A Contusion of unspecified index finger with damage to nail, initial encounter
S60.129D Contusion of unspecified index finger with damage to nail, subsequent encounter
S60.129S Contusion of unspecified index finger with damage to nail, sequela
S60.131A Contusion of right middle finger with damage to nail, initial encounter
S60.131D Contusion of right middle finger with damage to nail, subsequent encounter
S60.131S Contusion of right middle finger with damage to nail, sequela
S60.132A Contusion of left middle finger with damage to nail, initial encounter
S60.132D Contusion of left middle finger with damage to nail, subsequent encounter
S60.132S Contusion of left middle finger with damage to nail, sequela
S60.139A Contusion of unspecified middle finger with damage to nail, initial encounter
S60.139D Contusion of unspecified middle finger with damage to nail, subsequent encounter
S60.139S Contusion of unspecified middle finger with damage to nail, sequela
S60.141A Contusion of right ring finger with damage to nail, initial encounter
S60.141D Contusion of right ring finger with damage to nail, subsequent encounter
S60.141S Contusion of right ring finger with damage to nail, sequela
S60.142A Contusion of left ring finger with damage to nail, initial encounter
S60.142D Contusion of left ring finger with damage to nail, subsequent encounter
S60.142S Contusion of left ring finger with damage to nail, sequela
S60.149A Contusion of unspecified ring finger with damage to nail, initial encounter
S60.149D Contusion of unspecified ring finger with damage to nail, subsequent encounter
S60.149S Contusion of unspecified ring finger with damage to nail, sequela
S60.151A Contusion of right little finger with damage to nail, initial encounter
S60.151D Contusion of right little finger with damage to nail, subsequent encounter
S60.151S Contusion of right little finger with damage to nail, sequela
S60.152A Contusion of left little finger with damage to nail, initial encounter
S60.152D Contusion of left little finger with damage to nail, subsequent encounter
S60.152S Contusion of left little finger with damage to nail, sequela
S60.159A Contusion of unspecified little finger with damage to nail, initial encounter
S60.159D Contusion of unspecified little finger with damage to nail, subsequent encounter
S60.159S Contusion of unspecified little finger with damage to nail, sequela
S61.101A Unspecified open wound of right thumb with damage to nail, initial encounter
S61.101D Unspecified open wound of right thumb with damage to nail, subsequent encounter
S61.101S Unspecified open wound of right thumb with damage to nail, sequela
S61.102A Unspecified open wound of left thumb with damage to nail, initial encounter
S61.102D Unspecified open wound of left thumb with damage to nail, subsequent encounter
S61.102S Unspecified open wound of left thumb with damage to nail, sequela
S61.109A Unspecified open wound of unspecified thumb with damage to nail, initial encounter
S61.109D Unspecified open wound of unspecified thumb with damage to nail, subsequent encounter
S61.109S Unspecified open wound of unspecified thumb with damage to nail, sequela
S61.111A Laceration without foreign body of right thumb with damage to nail, initial encounter
S61.111D Laceration without foreign body of right thumb with damage to nail, subsequent encounter
S61.111S Laceration without foreign body of right thumb with damage to nail, sequela
S61.112A Laceration without foreign body of left thumb with damage to nail, initial encounter
S61.112D Laceration without foreign body of left thumb with damage to nail, subsequent encounter
S61.112S Laceration without foreign body of left thumb with damage to nail, sequela
S61.119A Laceration without foreign body of unspecified thumb with damage to nail, initial encounter
S61.119D Laceration without foreign body of unspecified thumb with damage to nail, subsequent encounter
S61.119S Laceration without foreign body of unspecified thumb with damage to nail, sequela
S61.121A Laceration with foreign body of right thumb with damage to nail, initial encounter
S61.121D Laceration with foreign body of right thumb with damage to nail, subsequent encounter
S61.121S Laceration with foreign body of right thumb with damage to nail, sequela
S61.122A Laceration with foreign body of left thumb with damage to nail, initial encounter
S61.122D Laceration with foreign body of left thumb with damage to nail, subsequent encounter
S61.122S Laceration with foreign body of left thumb with damage to nail, sequela
S61.129A Laceration with foreign body of unspecified thumb with damage to nail, initial encounter
S61.129D Laceration with foreign body of unspecified thumb with damage to nail, subsequent encounter
S61.129S Laceration with foreign body of unspecified thumb with damage to nail, sequela
S61.131A Puncture wound without foreign body of right thumb with damage to nail, initial encounter
S61.131D Puncture wound without foreign body of right thumb with damage to nail, subsequent encounter
S61.131S Puncture wound without foreign body of right thumb with damage to nail, sequela
S61.132A Puncture wound without foreign body of left thumb with damage to nail, initial encounter
S61.132D Puncture wound without foreign body of left thumb with damage to nail, subsequent encounter
S61.132S Puncture wound without foreign body of left thumb with damage to nail, sequela
S61.139A Puncture wound without foreign body of unspecified thumb with damage to nail, initial encounter
S61.139D Puncture wound without foreign body of unspecified thumb with damage to nail, subsequent encounter
S61.139S Puncture wound without foreign body of unspecified thumb with damage to nail, sequela
S61.141A Puncture wound with foreign body of right thumb with damage to nail, initial encounter
S61.141D Puncture wound with foreign body of right thumb with damage to nail, subsequent encounter
S61.141S Puncture wound with foreign body of right thumb with damage to nail, sequela
S61.142A Puncture wound with foreign body of left thumb with damage to nail, initial encounter
S61.142D Puncture wound with foreign body of left thumb with damage to nail, subsequent encounter
S61.142S Puncture wound with foreign body of left thumb with damage to nail, sequela
S61.149A Puncture wound with foreign body of unspecified thumb with damage to nail, initial encounter
S61.149D Puncture wound with foreign body of unspecified thumb with damage to nail, subsequent encounter
S61.149S Puncture wound with foreign body of unspecified thumb with damage to nail, sequela
S61.151A Open bite of right thumb with damage to nail, initial encounter
S61.151D Open bite of right thumb with damage to nail, subsequent encounter
S61.151S Open bite of right thumb with damage to nail, sequela
S61.152A Open bite of left thumb with damage to nail, initial encounter
S61.152D Open bite of left thumb with damage to nail, subsequent encounter
S61.152S Open bite of left thumb with damage to nail, sequela
S61.159A Open bite of unspecified thumb with damage to nail, initial encounter
S61.159D Open bite of unspecified thumb with damage to nail, subsequent encounter
S61.159S Open bite of unspecified thumb with damage to nail, sequela
S61.310A Laceration without foreign body of right index finger with damage to nail, initial encounter
S61.310D Laceration without foreign body of right index finger with damage to nail, subsequent encounter
S61.310S Laceration without foreign body of right index finger with damage to nail, sequela
S61.311A Laceration without foreign body of left index finger with damage to nail, initial encounter
S61.311D Laceration without foreign body of left index finger with damage to nail, subsequent encounter
S61.311S Laceration without foreign body of left index finger with damage to nail, sequela
S61.312A Laceration without foreign body of right middle finger with damage to nail, initial encounter
S61.312D Laceration without foreign body of right middle finger with damage to nail, subsequent encounter
S61.312S Laceration without foreign body of right middle finger with damage to nail, sequela
S61.313A Laceration without foreign body of left middle finger with damage to nail, initial encounter
S61.313D Laceration without foreign body of left middle finger with damage to nail, subsequent encounter
S61.313S Laceration without foreign body of left middle finger with damage to nail, sequela
S61.314A Laceration without foreign body of right ring finger with damage to nail, initial encounter
S61.314D Laceration without foreign body of right ring finger with damage to nail, subsequent encounter
S61.314S Laceration without foreign body of right ring finger with damage to nail, sequela
S61.315A Laceration without foreign body of left ring finger with damage to nail, initial encounter
S61.315D Laceration without foreign body of left ring finger with damage to nail, subsequent encounter
S61.315S Laceration without foreign body of left ring finger with damage to nail, sequela
S61.316A Laceration without foreign body of right little finger with damage to nail, initial encounter
S61.316D Laceration without foreign body of right little finger with damage to nail, subsequent encounter
S61.316S Laceration without foreign body of right little finger with damage to nail, sequela
S61.317A Laceration without foreign body of left little finger with damage to nail, initial encounter
S61.317D Laceration without foreign body of left little finger with damage to nail, subsequent encounter
S61.317S Laceration without foreign body of left little finger with damage to nail, sequela
S61.318A Laceration without foreign body of other finger with damage to nail, initial encounter
S61.318D Laceration without foreign body of other finger with damage to nail, subsequent encounter
S61.318S Laceration without foreign body of other finger with damage to nail, sequela
S61.319A Laceration without foreign body of unspecified finger with damage to nail, initial encounter
S61.319D Laceration without foreign body of unspecified finger with damage to nail, subsequent encounter
S61.319S Laceration without foreign body of unspecified finger with damage to nail, sequela
S61.320A Laceration with foreign body of right index finger with damage to nail, initial encounter
S61.320D Laceration with foreign body of right index finger with damage to nail, subsequent encounter
S61.320S Laceration with foreign body of right index finger with damage to nail, sequela
S61.321A Laceration with foreign body of left index finger with damage to nail, initial encounter
S61.321D Laceration with foreign body of left index finger with damage to nail, subsequent encounter
S61.321S Laceration with foreign body of left index finger with damage to nail, sequela
S61.322A Laceration with foreign body of right middle finger with damage to nail, initial encounter
S61.322D Laceration with foreign body of right middle finger with damage to nail, subsequent encounter
S61.322S Laceration with foreign body of right middle finger with damage to nail, sequela
S61.323A Laceration with foreign body of left middle finger with damage to nail, initial encounter
S61.323D Laceration with foreign body of left middle finger with damage to nail, subsequent encounter
S61.323S Laceration with foreign body of left middle finger with damage to nail, sequela
S61.324A Laceration with foreign body of right ring finger with damage to nail, initial encounter
S61.324D Laceration with foreign body of right ring finger with damage to nail, subsequent encounter
S61.324S Laceration with foreign body of right ring finger with damage to nail, sequela
S61.325A Laceration with foreign body of left ring finger with damage to nail, initial encounter
S61.325D Laceration with foreign body of left ring finger with damage to nail, subsequent encounter
S61.325S Laceration with foreign body of left ring finger with damage to nail, sequela
S61.326A Laceration with foreign body of right little finger with damage to nail, initial encounter
S61.326D Laceration with foreign body of right little finger with damage to nail, subsequent encounter
S61.326S Laceration with foreign body of right little finger with damage to nail, sequela
S61.327A Laceration with foreign body of left little finger with damage to nail, initial encounter
S61.327D Laceration with foreign body of left little finger with damage to nail, subsequent encounter
S61.327S Laceration with foreign body of left little finger with damage to nail, sequela
S61.328A Laceration with foreign body of other finger with damage to nail, initial encounter
S61.328D Laceration with foreign body of other finger with damage to nail, subsequent encounter
S61.328S Laceration with foreign body of other finger with damage to nail, sequela
S61.329A Laceration with foreign body of unspecified finger with damage to nail, initial encounter
S61.329D Laceration with foreign body of unspecified finger with damage to nail, subsequent encounter
S61.329S Laceration with foreign body of unspecified finger with damage to nail, sequela
S61.330A Puncture wound without foreign body of right index finger with damage to nail, initial encounter
S61.330D Puncture wound without foreign body of right index finger with damage to nail, subsequent encounter
S61.330S Puncture wound without foreign body of right index finger with damage to nail, sequela
S61.331A Puncture wound without foreign body of left index finger with damage to nail, initial encounter
S61.331D Puncture wound without foreign body of left index finger with damage to nail, subsequent encounter