When Exactly Can You Use CPT Code 11755?

When a patient presents with a dystrophic toenail, we often send a sample of the affected nail for culture, pathology and/or molecular genetic testing. If you obtain this sample by clipping off a distal portion of the nail plate and scraping out subungual debris, the question is often asked if you should code this with CPT 11755. 

The short answer to the above question is “no.” The description of CPT 11755 is “Biopsy of nail unit (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure).”

That “e.g.” can be confusing because that actually means “for example.” This may lead one to believe that sampling any of the listed components of nail anatomy would warrant use of the code. On the other hand, most agree that the term “nail unit” includes all of these components, not just one or more.

Fortunately, a CPT Assistant article published in December 2002 provided clarity on this question.¹ The article references several techniques that warrant the use of CPT 11755. The first involves placing a small punch through the nail plate and into the nail bed. The second technique listed in the article involves removal of the nail plate, a longitudinal incision over the affected area, removal of the specimen and suture closure.

The final example in the article is biopsy of the nail matrix. The article describes this as short, longitudinal incisions made on either side of the proximal nail fold in line with the lateral nail folds and elevation of this tissue off the proximal nail plate. A portion of that tissue is then removed to allow access to the nail matrix, from which a specimen is removed using a punch or a scalpel. This final example also describes suture closure.

Do not use CPT 11755 when clipping a piece of distal nail plate and scraping out subungual debris. The CPT Assistant article referenced above gives three examples of when one may use CPT 11755.

References

1. CPT Assistant. Nails. December 2002.

2. APMA Coding Resource Center. Available at  https://www.apmacodingrc.org/home.asp .

Dr. Lehrman is on the APMA Coding Committee, serves as an expert panelist on Codingline and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman