Summary & Overview
CPT 11740: Evacuation of Nail Hematoma, Incision and Drainage
CPT code 11740 covers the incision and drainage procedure used to evacuate a nail hematoma—draining blood from beneath a fingernail or toenail. This minor surgical service is commonly performed in ambulatory settings to relieve pain and prevent nail deformity. Nationally, the code is relevant across outpatient clinics, urgent care centers, physician offices, and emergency departments where immediate decompression of subungual hematomas is needed.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses coverage patterns, documentation expectations, and common clinical contexts where 11740 is reported. Readers will find concise benchmarks on typical service locations and payer considerations, a review of clinical indications tied to the procedure, and guidance on coding clarity for billing and administrative staff. The publication highlights where policy updates or payer-specific guidelines commonly affect claim acceptance and outlines practical documentation elements that support medical necessity for this minor surgical service.
This national overview is intended for clinicians, billing teams, and policy analysts seeking a clear, concise reference on the clinical purpose and billing context of CPT code 11740.
Billing Code Overview
CPT code 11740 describes the incision and drainage procedure used when a clinician evacuates a nail hematoma—that is, drains blood that has collected beneath a fingernail or toenail. This procedure is a minor surgical service intended to relieve pressure, reduce pain, and prevent nail deformity when blood accumulates under the nail plate.
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Service type: Minor surgical procedure, nail bed decompression
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Typical site of service: Office, urgent care, outpatient clinic, or emergency department
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Clinical & Coding Specifications
Clinical Context
A patient presents to an urgent care clinic after a blunt trauma to a finger 24 hours earlier. The patient reports acute throbbing pain and notes a dark discoloration beneath the fingernail. On exam the provider visualizes a subungual hematoma occupying approximately 40–60% of the nail plate with intense localized pain on palpation and percussion. The clinician discusses options with the patient and performs nail trephination to evacuate the hematoma using a sterile heated probe or needle to create a small opening in the nail, allowing decompression of the subungual blood collection.
The typical clinical workflow includes triage and focused history, targeted neurovascular and infection assessment, informed consent, antiseptic prep and local anesthetic if needed, sterile trephination technique to evacuate the hematoma, hemostasis and dressing, patient discharge instructions about wound care and follow-up if concern for nail bed laceration or fracture exists. The usual site of service is an emergency department or urgent care clinic; this procedure is also performed in an outpatient clinic setting. The service type is minor surgical/office or E/M procedure for drainage of blood beneath the nail corresponding to 11740.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 11740 due to severity or complexity. |
23 | Unusual anesthesia | Use if general or significant regional anesthesia is required beyond local anesthesia. |
25 | Significant, separately identifiable E/M service | Use when a significant evaluation and management visit is performed on the same day as 11740. |
50 | Bilateral procedure | Use if 11740 is performed on both corresponding digits (left and right) and payer allows bilateral modifier application. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as described. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances. |
59 | Distinct procedural service | Use when another distinct procedure is performed on the same day and documentation supports separate service. |
76 | Repeat procedure by same physician | Use when the same physician repeats 11740 during the same encounter. |
RT | Right side | Use to indicate the procedure was performed on the right digit when laterality is required. |
LT | Left side | Use to indicate the procedure was performed on the left digit when laterality is required. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services with assistant at surgery | Use when one of these clinicians is documented as assisting. |
QK | Medical direction of two, three, or four ancillary personnel | Use rarely when applicable in documented scenarios requiring medical direction. |
QX | CRNA service with qualified non-physician anesthetist | Use if a CRNA provided anesthesia services associated with the procedure. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Family Medicine | Commonly performs minor procedures in urgent care or office settings. |
207R00000X | Emergency Medicine | Frequently performs nail trephination in ED settings. |
207K00000X | Internal Medicine | May perform in outpatient clinic when urgent access is available. |
363A00000X | Podiatry | Performs toenail-related trephination for subungual hematomas of the toes. |
208000000X | General Practice | Performs minor surgical procedures in office or urgent care environments. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S60.211A | Contusion of right fingernail without damage to nail | Represents traumatic subungual hematoma of a right finger where 11740 is applicable. |
S60.212A | Contusion of left fingernail without damage to nail | Represents traumatic subungual hematoma of a left finger appropriate for trephination. |
S60.221A | Contusion of right toenail without damage to nail | Represents traumatic subungual hematoma of a right toe where trephination may be performed. |
S60.222A | Contusion of left toenail without damage to nail | Represents traumatic subungual hematoma of a left toe appropriate for evacuation. |
S61.231A | Laceration without foreign body of fingernail with damage to nail | Relevant when nail bed laceration is present; may require more extensive repair beyond 11740. |
S61.232A | Laceration without foreign body of toenail with damage to nail | Relevant for toe injuries with nail bed involvement necessitating additional procedures. |
S70.01XA | Contusion of nail of unspecified finger(s) | Used when laterality is not specified at initial coding but clinical relevance remains for hematoma evacuation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11730 | Avulsion of nail plate, partial or complete, simple (eg, for ingrown nail) | May be performed if trephination is inadequate or if there is an associated nail plate injury requiring removal after hematoma evacuation. |
11055 | Paring or cutting of benign hyperkeratotic lesion (eg, corn, callus); single lesion | Sometimes performed by the same clinicians in podiatry or foot clinics during the same visit for coexisting nail/skin conditions. |
99024 | Postoperative follow-up visit, included in global period | Used for routine follow-up within the global period when applicable; documents related post-procedural care. |
10060 | Incision and drainage of simple abscess (cutaneous/subcutaneous) | Performed if an accompanying soft tissue abscess is identified and requires drainage in addition to nail trephination. |
20550 | Injection(s); single tendon sheath, or ligament, aponeurosis | Occasionally used when a steroid injection is indicated for adjacent tenosynovitis identified during evaluation. |
99070 | Supplies and materials (specified by payer) | Used to report significant additional disposable supplies required beyond usual practice for the procedure. |