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2025 CPT code 11720

Debridement of one to five nails using any method.

Modifiers F1-F9, FA, T1-T9, and TA are used to specify the location and digit(s) treated.Medicare and most payers require documentation to justify medical necessity for nail debridement.

Modifiers 22 (Increased Procedural Services), 52 (Reduced Services), 59 (Distinct Procedural Service), and others may be applicable depending on the circumstances.Modifiers F1-F9, FA, T1-T9, and TA should be used to specify the affected digit and whether it's on the hand or foot.

Medical necessity is established when the nail condition causes pain, infection, or impairs ambulation.Conditions such as onychomycosis (fungal nail infection), significant hypertrophy (thickening) of the nail, and trauma may warrant debridement.Documentation must demonstrate the need for the procedure to improve the patient's condition and function.

The provider performs the surgical debridement of the affected nail(s) using appropriate instruments and techniques.This may involve removing portions or all of the affected nail(s) to treat the underlying condition.

IMPORTANT:For drainage of paronychia or onychia, see codes 10060 and 10061. For debridement of six or more nails, see code 11721.

In simple words: The doctor removes or cleans one to five diseased or infected nails. This might involve using special tools or an electric grinder to treat problems like fungal infections.The doctor will add information to specify which nail(s) were treated.

This CPT code encompasses the surgical debridement (removal or reduction of abnormal tissue) of one to five nails.The method of debridement is not specified and can include manual techniques with surgical instruments or the use of an electric grinder.This procedure is indicated for the treatment of various nail conditions, including onychomycosis (fungal nail infection),painful nails, or nails that impede ambulation, particularly in patients with diabetes, neurological, or vascular diseases.The nails may be abnormal, diseased, or infected.For debridement of six or more nails, code 11721 should be used.Appropriate modifiers (F1-F9, FA, T1-T9, TA) should be added to specify the location (hand or foot) and digit(s) treated.

Example 1: A 65-year-old diabetic patient presents with a thickened, painful toenail due to onychomycosis. The physician performs a debridement of the affected great toenail (T5)., A 40-year-old patient with a history of peripheral neuropathy presents with a severely ingrown toenail causing significant pain and inflammation.The physician debride the affected nail (T6) and performs a partial nail avulsion., A 28-year-old patient presents with a traumatic nail injury resulting in a severely damaged fingernail. The physician surgically debride the damaged nail (F1).

Detailed medical history, including the presence of any underlying conditions such as diabetes or peripheral vascular disease.A clear description of the nail(s) affected, the extent of the debridement performed, and the method(s) used.Documentation should support medical necessity, such as presence of pain, infection, or impaired ambulation.

** Routine nail care is generally not covered by Medicare or most payers.Thorough documentation is crucial for reimbursement.

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