CPT 11750: Excision of Nail Plate and Matrix (Partial or Complete)

CPT code 11750 represents surgical excision of part or all of a fingernail or toenail, including removal of the nail plate and matrix and the lunula when excision is complete. As a common minor surgical procedure, this code is used across dermatology, podiatry, and primary care settings and has implications for coding accuracy, coverage determinations, and outpatient procedural workflows nationwide. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will learn the clinical scope of the procedure, typical sites of service, how this code relates to nearby CPT codes for simpler avulsion or related nail procedures, and common documentation elements needed to support medical necessity. The summary outlines payer coverage patterns and common contractual considerations without offering clinical recommendations. The piece also highlights coding distinctions that affect billing, such as when complete removal including the matrix and lunula is performed versus simpler avulsion procedures, and provides context for clinicians and billing staff to align documentation with claim submission. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 11750 describes the surgical removal of part or all of a fingernail or toenail, including excision of the nail plate and the nail matrix and including the lunula when the excision is complete. This procedure is a definitive nail excision typically performed to treat severe nail disease, traumatic injury, or recurrent infection.

Service Type: Surgical procedure, nail excision

Typical Site of Service: Outpatient clinic, ambulatory surgery center, or physician office procedure room

Clinical Context

A 34-year-old patient presents to an outpatient dermatology or podiatry clinic with acute pain, bleeding, and visible deformity of the right great toe nail following a crush injury. Examination shows an open bite injury to the nail with avulsed nail plate and suspected damage to the nail matrix and lunula. After informed consent, the clinician performs a complete nail excision (removal of the nail plate and matrix) under local anesthesia in a procedure room. Hemostasis is obtained, the nail bed is inspected for foreign material, and a sterile dressing is applied. Post‑procedure instructions include wound care, analgesia, tetanus status review, and follow‑up for wound check and possible wound care or antibiotic management if indicated. Typical sites of service are outpatient clinic procedure rooms, dermatology office, podiatry office, or ambulatory surgical centers for more complex cases.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service on the same day	Use when an E/M visit is documented separately and clearly distinct from the nail excision procedure.
`59`	Distinct procedural service

Taxonomy Code	Specialty	Notes
`207ND0101X`	Dermatology Physician	Dermatologists commonly perform nail matricectomy and full nail excision for traumatic or infectious indications.
`213ES0103X`	Podiatrist	Podiatrists frequently manage toe nail injuries and perform complete nail excision in-office.
`207Q00000X`	Family Medicine Physician	Family physicians may perform nail removal procedures in office settings for acute injuries or infections.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S90.211A-S`	Open bite of right great toe, initial encounter (and sequela variants)	Direct traumatic injury to the nail apparatus of the right great toe that may necessitate complete nail excision and matrix removal.
`S90.212A-S`	Open bite of left great toe, initial encounter (and sequela variants)	Traumatic open bite to the left great toe involving the nail unit; indicates need for debridement and possible nail excision.
`S90.221A-S`	Open bite of right second toe, initial encounter (and sequela variants)	Injury to the second toe nail complex on the right foot that can require nail removal for wound management and inspection.
`S90.222A-S`	Open bite of left second toe, initial encounter (and sequela variants)	Injury to the left second toe nail complex associated with exposed nail bed or matrix often managed with excision of the nail.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11730`	Avulsion of nail plate, partial or complete, simple; single	Alternative, less extensive procedure when only the nail plate is removed without matrix excision.
`11732`	Avulsion of nail plate, partial or complete, each additional separate (e.g., subsequent) procedure	Billed when multiple separate nails are avulsed during the same encounter as additional procedures.
`11765`	Excision of nail fold, toe; wedge resection	Performed when chronic or traumatic nail fold pathology requires wedge excision in addition to or instead of full nail excision.

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Summary & Overview