2025 CPT code 11721
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures Integumentary System Feed
Surgical debridement of six or more nails.
Modifiers 22 (increased procedural services), 52 (reduced services), 53 (discontinued procedure), and others as needed to clarify the circumstances of the procedure may be applicable.Also, appropriate modifiers to indicate location (hand/foot and specific digit) are necessary (e.g., F1-F9, FA, T1-T9, TA).
Medical necessity for this procedure is generally established when the diseased or damaged nails significantly impair the patient's daily life activities, cause pain, or create a risk for infection.Conditions such as severe onychomycosis, significant trauma, or significant nail hypertrophy impacting ambulation may justify the procedure.Documentation must demonstrate the medical necessity to the payer's satisfaction.
The clinical responsibility lies with the physician or other qualified healthcare professional performing the surgical debridement.This includes proper diagnosis, informed consent, surgical procedure, post-operative care, and documentation.
In simple words: This code describes the surgical removal or cleaning of six or more unhealthy nails.A doctor uses tools to carefully remove the diseased or damaged parts of the nails.
This CPT code encompasses the surgical debridement (removal or reduction of abnormal tissue) of six or more nails that are diseased, abnormal, or infected.The debridement may be performed using various methods, including manual techniques with surgical instruments or electric grinders. This procedure addresses conditions such as onychomycosis (fungal nail infection), significant nail hypertrophy (excessive thickening or deformation), or other pathologies causing significant nail damage impacting ambulation or daily function.
Example 1: A diabetic patient presents with six severely thickened and deformed toenails due to onychomycosis. The physician performs surgical debridement of all six toenails to improve hygiene and ambulation., A patient with a significant fungal nail infection affecting all ten fingernails undergoes surgical debridement to remove the infected portions of the nails. Appropriate use of modifiers is required., A patient with peripheral neuropathy presents with six painful ingrown toenails. Surgical debridement is performed to alleviate pain and prevent further complications.
* Comprehensive history and physical examination documenting the need for debridement.* Detailed description of the condition of each nail.* Pre-operative and post-operative photographs (if applicable).* Documentation of the type and amount of tissue removed for each nail.* Complete procedure notes detailing the technique used.
** Medicare and most payers do not cover routine nail care.The service must be medically necessary to be reimbursed.Always verify coverage with the specific payer prior to performing the procedure and coding.
- Revenue Code: P6A (Minor Procedures - Skin)
- RVU: Information not provided.RVUs vary depending on geographic location and other factors. Consult your local Medicare Administrative Contractor (MAC) for specific values.
- Global Days: Information not provided.The global period for this procedure would need to be determined based on local payer guidelines and may not be applicable.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier may apply depending on the circumstances of the procedure and payer guidelines.Further clarification may be needed from your payer.
- Fee Schedule: Information not provided. Fee schedules vary by payer and geographic location. Consult your payer's fee schedule.
- Specialties:Podiatry, Dermatology, General Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgery Center