Appropriate Use of CPT® 11755

February 28, 2022

CPT® 11755 – Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)

This CPT code is often used incorrectly.  The “e.g.” in the code descriptor can be confusing because that translates to, “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, clarity is provided in the form of a CPT Assistant article published in December, 2002. The article references three procedures which 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 given in the article is biopsy of the nail matrix. This is described in the article 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.

CPT 11755 should not be used when clipping a piece of distal nail plate and/or removing subungual debris. The CPT Assistant article referenced above gives three examples of when CPT 11755 may be used. This code is often used associated with the procedures performed when biopsy of a subungual neoplasm is performed.


References

2022 CPT Professional. Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2021 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

CPT Assistant December, 2002  “Nails”

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA

Dr. Lehrman is a Board Certified Podiatrist, Certified Professional Coder, and Certified Professional Medical Auditor. He is in private practice in Colorado and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation.

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