Summary & Overview
CPT 11730: Avulsion of Nail Plate, Partial or Complete, Single
Headline: CPT 11730 — Simple Single Nail Plate Avulsion, Common Dermatologic Office Procedure
Lead: CPT 11730 documents a simple partial or complete avulsion of a single nail plate performed in an outpatient dermatology setting. It is a widely used code for treating nail conditions that require removal of the nail plate and is relevant across payers and clinical practices.
What this code represents and why it matters: CPT 11730 captures a common, low-complexity dermatologic surgical procedure. Accurate use of the code affects clinical documentation, billing consistency, and claims adjudication for nail-related procedures performed in office settings. Its application is important for appropriate payment and for distinguishing this service from more complex nail excisions and reconstructive procedures.
Key payers covered: This summary addresses coverage considerations for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides benchmarks for coding and billing CPT 11730, explains relevant clinical contexts in which the code is used, and compares related procedural codes to clarify when CPT 11730 is the appropriate code versus add-on or more extensive nail procedures. It also summarizes common payer considerations and documentation elements needed for claims processing.
Data limitations: Data not available in the input for service line specifics and payer policy details; readers should consult payer policy manuals for definitive coverage rules.
CPT Code Overview
CPT 11730 describes avulsion of nail plate, partial or complete, simple; single. This procedure is classified under dermatologic surgery and involves removal of all or part of a nail plate from a single digit. The typical setting for the service is the outpatient office (POS 11).
Clinical & Coding Specifications
A patient presents to an outpatient dermatology office (POS 11) with a symptomatic nail disorder such as an ingrowing toenail causing pain and localized inflammation. The clinician evaluates the affected digit, documents history and focused exam, and determines that a simple avulsion of the nail plate is indicated. After informed consent, local anesthesia is administered to the digit, and a partial or complete avulsion of the nail plate is performed on a single nail. Hemostasis is achieved, a dressing is applied, and post-procedure wound care and follow-up are documented. The encounter includes identification of the specific digit using an identifying digit modifier when required, and the procedure is coded as 11730.
Modifiers:
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KX: Used when a repeat nail avulsion is performed on the same finger less than 4 months or the same toe less than 8 months and the service is reasonable and necessary. -
identifying digit modifiers: Used to indicate the specific digit on which the procedure is performed (to identify the treated nail).
Provider Taxonomies:
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207NP0225X: Pediatric Dermatology Physician — represents dermatologists with a pediatric focus. -
207NS0135X: Procedural Dermatology Physician — represents dermatologists who perform procedural dermatology including minor surgical procedures.
Notes: