2025 CPT code 11755
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Integumentary System Surgery Feed
Biopsy of nail unit (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) - a separate procedure.
Modifiers 50 (bilateral procedure), 51 (multiple procedures), 59 (distinct procedural service), LT (left side), RT (right side), 76 (repeat procedure by same physician), 77 (repeat procedure by another physician), 78 (unplanned return to OR), 79 (unrelated procedure), and 99 (multiple modifiers) may be applicable depending on the circumstances of the procedure.
The medical necessity of a nail unit biopsy is established by the presence of clinical findings suggestive of underlying pathology such as:* Pigmented lesions raising concern for melanoma.* Persistent pain or swelling.* Unusual nail growth or changes.* Suspicion of infection or other conditions requiring microscopic examination for diagnosis and treatment planning.The clinical findings should be documented and must clearly support the necessity of the biopsy.
The physician's responsibility includes performing the biopsy of the nail unit (nail plate, bed, matrix, hyponychium, proximal and lateral nail folds), using appropriate techniques to obtain a representative tissue sample, ensuring proper wound closure with sutures where necessary, and providing appropriate post-procedure care and patient education.
In simple words: This code covers taking a small tissue sample from a nail or the skin around it for testing.The doctor might take a sample from the nail itself, the area under the nail, or the skin near the nail. It is done to check for problems like infections or tumors. Because each sample taken is considered a separate procedure, it might be billed multiple times if samples are taken from multiple sites.
CPT code 11755 represents a biopsy of the nail unit, encompassing the nail plate, bed, matrix, hyponychium, proximal, and lateral nail folds.This is considered a separate procedure from other nail procedures and involves removing a tissue sample for pathological examination.The procedure may involve techniques such as a punch biopsy through the nail plate, complete nail plate removal with incision and suture closure, or a biopsy of the nail matrix requiring incisions around the proximal nail fold and subsequent suture closure. The specific technique depends on the location and nature of the suspected pathology.Each sampled area constitutes a separate procedure, and appropriate documentation is crucial for accurate coding.
Example 1: A patient presents with a suspected subungual melanoma.The physician performs a biopsy of the nail bed using a punch biopsy technique through the nail plate. Code 11755 is used to report this procedure., A patient presents with a lesion in the nail matrix.The physician removes the nail plate, makes longitudinal incisions to access the matrix, removes a tissue specimen, and closes the wound with sutures. Code 11755 is used to report this procedure. , A patient presents with suspicious tissue in multiple areas of the nail unit. The physician performs biopsies of the nail plate, bed, and hyponychium. Each biopsy is separately coded using code 11755, with modifier 51 for multiple procedures.
* Detailed description of the procedure performed, including the specific area(s) of the nail unit biopsied.* Indication for the biopsy (e.g., suspicion of malignancy, infection, other pathology).* Type of biopsy technique used.* Number of specimens taken from different sites, if applicable.* Size and location of the incision(s).* Description of wound closure technique.* Pathology report results.* Postoperative care instructions.
** Accurate coding of 11755 requires detailed documentation specifying the specific location(s) of the nail unit biopsied.Simple nail clippings sent for fungal analysis should not be coded with 11755.Consult the AMA's CPT codebook and the most current NCCI edits for the most accurate and up-to-date coding guidelines.
- Revenue Code: P5A (AMBULATORY PROCEDURES - SKIN)
- RVU: RVUs vary based on several factors, including geographic location, facility type, and complexity of the procedure. Consult a medical billing resource or the AMA's CPT codebook for specific RVU values.
- Global Days: Not applicable. This is not a surgical procedure with a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule information is not available in the provided source data. This information is dependent on various factors and is subject to change.
- Specialties:Dermatology, Surgical Oncology, Podiatry
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center