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September 16, 2024

Repeat Nail Avulsions CPT® 11730 and 11732

Repeat nail avulsion is defined as repeat avulsions performed within 32 weeks following a previous avulsion of the same digit. The documentation must demonstrate this was medically necessary. Examples of medical necessity include an ingrown nail of the opposite border or new significant pathology on the same border recently treated digit.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures

Signed and dated office visit record/operative

For a reasonable and necessary repeat nail avulsion on the same finger less than 4 months (16 weeks) or the same toe less than 8 months (32 weeks) following a previous avulsion, the KX modifier must be appended to the claim. The medical record documentation must be specific as to the indication, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated.

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