{"id":180961,"date":"2026-08-18T07:23:02","date_gmt":"2026-08-18T07:23:02","guid":{"rendered":"https:\/\/pabau.com\/?p=180961"},"modified":"2026-08-18T14:01:52","modified_gmt":"2026-08-18T14:01:52","slug":"cpt-code-11752","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11752\/","title":{"rendered":"CPT Code 11752: Nail and nail matrix excision billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 11752: Nail and nail matrix excision billing guide\",\"description\":\"CPT Code 11752 covers excision of nail and nail matrix (partial or complete) with amputation of the tuft of the distal phalanx. Learn code status, modifiers, ICD-10 pairings, and Medicare reimbursement.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11752\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-15\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT Code 11752 covers excision of the nail and nail matrix for permanent removal, with amputation of the distal phalanx tuft.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>AAPC lists CPT 11752 as a deleted code, so confirm the current crosswalk with your MAC before you bill it.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT 11750 covers the nail and matrix excision alone. If bone was also excised, 28124 or 28160 may apply.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Digit modifiers (FA, F1-F9, TA, T1-T9) and laterality modifiers (-LT, -RT) identify the exact digit treated on every claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau prompts for the required modifiers, so nail surgery claims leave your practice complete.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT Code 11752 covers excision of the nail and nail matrix for permanent removal, with amputation of the tuft of the distal phalanx. That bony component is what separates it from CPT 11750, which stops at the matrix.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">AAPC&#8217;s code lookup now lists 11752 as deleted, so it is a crosswalk decision rather than a billing choice. This guide covers the descriptor, the crosswalk, modifiers, ICD-10 pairings, Medicare payment, and the documentation an auditor will ask for.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-cpt-code-11752-definition-and-clinical-description\" class=\"wp-block-heading\">CPT Code 11752: Definition and clinical description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The full descriptor is excision of nail and nail matrix, partial or complete, for permanent removal, with amputation of the tuft of the distal phalanx. The American Medical Association maintains the CPT code set and files this code under surgical procedures on the nails.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The defining clinical feature is the distal phalanx involvement. CPT 11750 covers nail and matrix excision for permanent removal. CPT 11752 added amputation of the bony tuft at the tip of the toe or finger.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Podiatrists and dermatologists treating severely deformed or chronically ingrown nails are the primary billers. Practices running <a href=\"https:\/\/pabau.com\/industry\/dermatology-emr-software\/\">dermatology EMR software<\/a> with integrated billing can flag the anatomical distinction at the point of documentation.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11752<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail) for permanent removal; with amputation of tuft of distal phalanx<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Procedure category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical procedures on the nails<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deleted per AAPC \u2014 verify the crosswalk before billing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">010 days (verify with current CMS fee schedule)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary indications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ingrown nail (onychocryptosis), severely deformed nail<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical specialties<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Podiatry, dermatology, general surgery<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-is-cpt-code-11752-deleted-status-and-crosswalk\" class=\"wp-block-heading\">Is CPT Code 11752 deleted? Status and crosswalk<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">AAPC&#8217;s code lookup lists CPT Code 11752 as deleted. A deleted status means the AMA removed the code from the active CPT set in a given code year. Claims submitted under that number are rejected as invalid.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Take three steps before billing any nail procedure previously coded as 11752.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Confirm the deletion year and effective date with the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC CPT code lookup<\/a> or the AMA CPT manual for the relevant code year<\/li>\n\n\n\n<li>Identify the current replacement or crosswalk code with your Medicare Administrative Contractor (MAC)<\/li>\n\n\n\n<li>Update any fee schedules, superbills, or charge capture templates that still reference the old code number<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11750\/\">CPT 11750<\/a> is the closest active nail code and covers the nail and matrix excision on its own. If the operative note also documents excision of the distal phalanx tuft, 28124 or 28160 may apply in addition, per MAC guidance. Review the note before you pick either one, and confirm the substitution with your MAC or a certified coder.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor summary<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Status<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11752<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Nail\/matrix excision, permanent removal, with distal phalanx tuft amputation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deleted \u2014 do not bill<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11750<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision of nail and nail matrix, partial or complete, for permanent removal<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active \u2014 primary crosswalk candidate<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11730<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Avulsion of nail plate, partial or complete, simple; single<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">28124 \/ 28160<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Partial excision of phalanx \/ partial amputation of toe<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active \u2014 only where bone was also excised<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-procedure-description-nail-and-nail-matrix-excision-with-distal-phalanx-amputation\" class=\"wp-block-heading\">Procedure description: nail and nail matrix excision with distal phalanx amputation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 11752 involves two distinct anatomical components. The surgeon excises the nail plate, then removes or destroys the nail matrix, the tissue that grows the nail. That achieves permanent removal. The procedure then extends to the bony tuft at the tip of the distal phalanx, the terminal bone of the digit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Common indications include onychocryptosis, or ingrown nail, with recurrent infection. Severely deformed nails causing pain also qualify, as do cases where matrix destruction alone leaves an underlying bony deformity untreated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Podiatry practices handle most of this volume. <a href=\"https:\/\/pabau.com\/industry\/lp\/podiatry-software\/\">Podiatry software<\/a> with structured note templates helps capture the bony involvement that justifies this level of procedure.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Nail plate removal:<\/strong> The nail plate is detached from the nail bed and surrounding tissue<\/li>\n\n\n\n<li><strong>Matrix excision:<\/strong> The germinal matrix is surgically excised or chemically destroyed to prevent regrowth<\/li>\n\n\n\n<li><strong>Distal phalanx amputation:<\/strong> The tuft (terminal portion) of the distal phalanx is amputated, distinguishing this from CPT 11750<\/li>\n\n\n\n<li><strong>Closure:<\/strong> The wound is closed with appropriate technique based on tissue condition and wound size<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-icd-10-codes-paired-with-cpt-11752\" class=\"wp-block-heading\">ICD-10 codes paired with CPT 11752<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medical necessity for nail surgery rests on the supporting ICD-10-CM diagnosis code. CMS Local Coverage Determination Article 57666 sets out which diagnoses support coverage for the nail surgery family. Use only the codes your MAC&#8217;s current LCD lists.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L60.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ingrowing nail<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary indication; verified in CMS LCD 57666<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L60.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Onycholysis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm against your MAC&#8217;s covered diagnosis list<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L60.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Onychogryphosis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deformed nail with permanent removal indication<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L60.8<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other nail disorders<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when specific diagnosis subtype not coded elsewhere<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q84.5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Enlarged and hypertrophic nails<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Congenital nail deformity with surgical indication<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">B35.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Tinea unguium (onychomycosis)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fungal nail infection requiring surgical removal<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Payers deny claims when the submitted diagnosis does not appear on the LCD&#8217;s covered list. Codes such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-l62\/\">L62<\/a> describe nail changes secondary to another condition, so they rarely stand alone on a surgical claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation matters as much as the code itself. The encounter note must tie each diagnosis to a documented clinical finding, and <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA compliance<\/a> governs how that record is stored.<\/p>\n\n\n\n<h2 id=\"h-modifiers-for-cpt-code-11752\" class=\"wp-block-heading\">Modifiers for CPT Code 11752<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Digit and laterality modifiers are required on all nail surgery claims. Payers use these to identify the specific digit treated, detect duplicate billing, and apply National Correct Coding Initiative (NCCI) edits. Missing or incorrect modifiers sit near the top of the <a href=\"https:\/\/pabau.com\/blog\/denial-codes-in-medical-billing\/\">denial codes<\/a> list for nail procedures.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Digit \/ Laterality<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Usage guidance<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">FA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left hand, thumb<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required when treating the left hand thumb<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F1-F9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hand digits other than the left thumb<\/td>\n<td style=\"padding:12px 16px;color:#374151\">F1 covers the left index finger and F5 the right thumb<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">TA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left foot, great toe<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common for ingrown great toenail procedures<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">T1-T9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Foot digits other than the left great toe<\/td>\n<td style=\"padding:12px 16px;color:#374151\">T1-T4 cover left foot 2nd-5th toes, T5 the right great toe, T6-T9 right foot 2nd-5th toes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-LT \/ -RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side \/ Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Some payers want laterality modifiers alongside digit modifiers. Check each payer&#8217;s policy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use to override NCCI bundling edits when procedures on separate digits are performed at the same session<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier requirements vary by payer, so check your MAC&#8217;s local coverage policy before you submit. Some commercial payers want both a digit modifier and a laterality modifier. Others accept one or the other.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">Digital medical forms<\/a> that prompt for the digit at the point of documentation cut the risk of a wrong or missing modifier.<\/p>\n\n\n\n<h2 id=\"h-reimbursement-and-medicare-payment-for-cpt-11752\" class=\"wp-block-heading\">Reimbursement and Medicare payment for CPT 11752<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Because CPT Code 11752 carries a deleted status, any reimbursement data tied to this code number should be treated as historical. Medicare pays nail surgery from the Resource-Based Relative Value Scale, known as RBRVS. Separate rates apply to facility and non-facility settings. The Geographic Practice Cost Index, or GPCI, then adjusts payment by practice location.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Query the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> lookup tool using the replacement code your MAC identifies. The 010-day global period bundles 10 days of post-operative care into the procedure payment. Separate E&amp;M services in that window require modifier -24 or modifier -79 to be separately reimbursable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Routine foot care exclusions catch out podiatry practices most often, so <a href=\"https:\/\/pabau.com\/blog\/insurance-eligibility-verification\/\">eligibility verification<\/a> before the visit is worth the minute it takes.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">010 days (verify with current CMS fee schedule)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Payment setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility and non-facility rates apply, with non-facility typically higher<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Geographic adjustment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rates vary by MAC jurisdiction via GPCI multiplier<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status impact<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deleted code \u2014 use current fee schedule data for the active replacement code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Post-op E&amp;M billing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Requires modifier -24 (unrelated) or -79 (unrelated procedure) during global period<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-documentation-requirements-for-billing-cpt-11752\" class=\"wp-block-heading\">Documentation requirements for billing CPT 11752<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Nail surgery claims are frequently flagged for post-payment audit because the procedures are straightforward, high-volume, and subject to specific LCD coverage criteria. Solid documentation is the primary defense against pre-payment denials and post-payment recoupment, and it is the backbone of <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">billing compliance<\/a>. CMS LCD Article 57666 sets out the documentation standards for nail surgery codes.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medical necessity statement:<\/strong> The note must say why permanent removal was chosen over conservative management. Reference the diagnosis, such as recurrent infection or failed conservative treatment<\/li>\n\n\n\n<li><strong>Operative note elements:<\/strong> Describe the anatomical structures involved and the surgical technique. Confirm that the matrix was excised and the tuft amputated<\/li>\n\n\n\n<li><strong>Pre-operative diagnosis:<\/strong> Document the diagnosis that prompted the procedure, mapped to the supporting ICD-10-CM code<\/li>\n\n\n\n<li><strong>Post-operative diagnosis:<\/strong> Confirm the clinical findings at the time of surgery, noting any difference from the pre-operative diagnosis<\/li>\n\n\n\n<li><strong>Digit identification:<\/strong> Record the specific digit(s) treated to support modifier selection on the claim<\/li>\n\n\n\n<li><strong>Bilateral documentation:<\/strong> If both sides of the same digit or multiple digits were treated, document each separately with distinct clinical findings<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation prompts at the point of the encounter capture the required elements while the surgeon still remembers the case. Asking a post-visit billing team to reconstruct an operative note from thin documentation invites both denials and compliance risk. The <a href=\"https:\/\/pabau.com\/blog\/practice-management-software-features\/\">practice management software features<\/a> that help here are procedure-linked note templates, structured operative note fields, and automated modifier prompting.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-11752\/fully-integrated-with-pabau-billing.webp\" alt=\"Pabau billing screen matching insurer remittances against individual claim lines\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s payment reconciliation matches each insurer remittance to the claim it paid, so an underpaid nail surgery line shows up the day it lands.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Before billing any nail surgery code, confirm the digit modifier in the patient record matches the digit listed in the operative note. A modifier that disagrees with the documented digit is an audit red flag. It is also a frequent denial trigger. Build a post-visit charge entry checklist that requires staff to cross-reference the operative note before the claim is submitted.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-ncci-bundling-edits-and-billing-guidelines-for-nail-surgery\" class=\"wp-block-heading\">NCCI bundling edits and billing guidelines for nail surgery<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/national-correct-coding-initiative-ncci-edits\" target=\"_blank\" rel=\"nofollow noopener\">National Correct Coding Initiative<\/a> (NCCI) bundling edits restrict which codes can be billed together on the same date of service. For nail surgery, the risk arises when several nail codes go out together. It also arises when a nail procedure is billed alongside wound care or debridement on the same digit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Trimming and debridement codes such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11719\/\">CPT 11719<\/a> are the usual counterparts in a nail bundling edit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier -59, distinct procedural service, can override a bundling edit when the two procedures genuinely differ. For nail surgery that usually means separate, clearly documented digits at the same session.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Some MACs prefer the X-modifiers as more specific alternatives to -59. XS covers a separate structure and XU an unusual non-overlapping service. Check your MAC&#8217;s published NCCI policy before you pick one. <a href=\"https:\/\/pabau.com\/blog\/ehr-integration\/\">EHR integration<\/a> with real-time coding edits catches these conflicts before the claim leaves the practice.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Do not bill CPT 11750 and CPT Code 11752 together for the same digit on the same date<\/li>\n\n\n\n<li>Do not bundle a simple nail avulsion (11730) with a complete matrix excision code for the same digit<\/li>\n\n\n\n<li>Modifier -59 or an X-modifier is required when two nail codes are billed for different digits at the same session<\/li>\n\n\n\n<li>Document each digit separately in the operative note if multiple digits are treated<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-cpt-11752-vs-related-nail-surgery-codes\" class=\"wp-block-heading\">CPT 11752 vs related nail surgery codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Selecting the correct nail removal CPT code depends on whether the procedure involves temporary avulsion, permanent matrix destruction, or bony amputation. The table below compares CPT Code 11752 with the most frequently billed alternatives in the nail surgery family. Confirm active status and current descriptors against the AMA CPT manual for the code year you are billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Procedure description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Matrix destruction?<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Bony involvement?<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Permanent removal?<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11730<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Avulsion of nail plate, partial or complete, simple; single<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No (temporary)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11732<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Avulsion of nail plate, each additional nail plate (list separately)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No (temporary)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11750<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision of nail and nail matrix, partial or complete, for permanent removal<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11752<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision of nail and nail matrix, with amputation of tuft of distal phalanx<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (deleted)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11755<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">N\/A (biopsy)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Before deletion, the choice between 11750 and 11752 turned entirely on one question. Was bony amputation of the distal phalanx tuft performed and documented? Without that documentation, moving from 11750 to 11752 was upcoding. When a second nail plate is avulsed at the same session, <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11732\/\">CPT 11732<\/a> is the add-on code to reach for.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a quarterly audit of your nail surgery claims using your practice management platform&#8217;s reporting tools. Filter by CPT codes in the 11730-11760 range, then check denial rates by modifier type. If FA or TA claims deny at a higher rate than your other digit modifiers, look at how the digit gets recorded. The fix almost always sits in the operative note.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-practice-management-software-simplifies-nail-surgery-billing\" class=\"wp-block-heading\">How practice management software simplifies nail surgery billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Four things can sink a nail surgery claim line, and manual charge entry exposes a practice to all four at once.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Digit-specific modifiers that must match the operative note<\/li>\n\n\n\n<li>LCD-governed diagnosis codes that vary by MAC jurisdiction<\/li>\n\n\n\n<li>NCCI bundling restrictions across the nail code family<\/li>\n\n\n\n<li>The deleted status of 11752 and the crosswalk it now requires<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau builds those rules into the billing workflow itself. Our <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> prompts for the digit as the clinician documents the excision.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It surfaces the modifier that digit requires, checks the ICD-10-CM code against the covered list, and flags NCCI conflicts before submission. <a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">Automated billing workflows<\/a> then carry the same checks across every provider and location, so your claim output stops depending on who did the charge entry.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Modifier prompting:<\/strong> The system flags missing digit or laterality modifiers before claim submission<\/li>\n\n\n\n<li><strong>Diagnosis code validation:<\/strong> ICD-10-CM codes are checked against LCD covered code lists in real time<\/li>\n\n\n\n<li><strong>NCCI edit alerts:<\/strong> Bundling conflicts surface at charge entry rather than in a denial letter<\/li>\n\n\n\n<li><strong>Deleted code detection:<\/strong> Billing rules can flag retired code numbers, preventing claims submitted under CPT Code 11752 after its deletion date<\/li>\n\n\n\n<li><strong>Audit-ready documentation:<\/strong> Structured note templates tied to specific procedure codes ensure the operative record contains the elements payers look for on review<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Manual superbill workflows make consistent coding across a multi-provider team hard to hold. Connecting documentation to billing through <a href=\"https:\/\/pabau.com\/blog\/best-medical-practice-management-software\/\">medical practice management software<\/a> gives billing managers visibility into coding patterns and denial trends.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Reduce nail surgery claim denials with Pabau                <\/h3>\n\n                <p class=\"description\">\n                    Pabau prompts for the digit and laterality modifiers each nail procedure needs. Documentation checklists sit in the same workflow, so claims go out complete the first time.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Knowing what 11752 described matters less now than making sure nobody in your practice still bills it. Flag the number in your billing rules, set the crosswalk your MAC confirms, and update every superbill and note template that still carries it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The trade-off worth remembering is that the crosswalk is a documentation decision before it is a coding one. If the operative note records only matrix excision, 11750 is the whole answer. If it records excision of the distal phalanx tuft as well, 28124 or 28160 belong on the claim beside it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that get this right build the check into the encounter rather than the appeal. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau turns modifier prompts and documentation checklists into part of your nail surgery billing workflow.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Missed a payer deadline on a nail surgery claim?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">Timely filing limits<\/a> lists the initial, corrected, and appeal windows by payer.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need to read the remittance that comes back?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/electronic-remittance-advice\/\">Electronic remittance advice<\/a> explains how to reconcile an ERA against what you billed.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Wondering what the claim file itself contains?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/837-file\/\">The 837 file<\/a> walks through the electronic claim format payers receive.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Not yet enrolled with the payers you bill?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/how-to-get-credentialed-with-insurance-companies\/\">How to get credentialed<\/a> covers the enrollment steps in order.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want the wider view of the billing cycle?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">Revenue cycle management<\/a> maps every stage from scheduling to posted payment.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786951853727\"><h3 class=\"schema-faq-question\">What does CPT Code 11752 cover?<\/h3> <p class=\"schema-faq-answer\">CPT Code 11752 covers excision of the nail and nail matrix for permanent removal. It also includes amputation of the tuft of the distal phalanx. That bony component makes it more extensive than CPT 11750, which stops at the matrix.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951853729\"><h3 class=\"schema-faq-question\">What is the replacement for CPT Code 11752?<\/h3> <p class=\"schema-faq-answer\">CPT 11750 covers the nail and matrix excision and is the closest active crosswalk code. If the operative note also documents excision of the distal phalanx tuft, 28124 or 28160 may apply in addition, per MAC guidance. Confirm the crosswalk with your MAC before billing, since the decision is payer-specific and documentation-dependent.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951853730\"><h3 class=\"schema-faq-question\">What modifiers are used with CPT Code 11752?<\/h3> <p class=\"schema-faq-answer\">Digit modifiers and laterality modifiers (-LT, -RT) are the primary modifiers for nail surgery codes. FA covers the left thumb and F1-F9 the remaining hand digits, with F5 as the right thumb. TA covers the left great toe, T1-T4 the left foot 2nd-5th toes, T5 the right great toe, and T6-T9 the right foot 2nd-5th toes. Modifier -59 or an X-modifier is needed when billing multiple nail codes for different digits at one session. Verify requirements with your MAC, since payer policies vary.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951853733\"><h3 class=\"schema-faq-question\">How does CPT 11752 differ from CPT 11750?<\/h3> <p class=\"schema-faq-answer\">CPT 11750 covers excision of the nail and nail matrix for permanent removal without bony involvement. CPT Code 11752 added amputation of the tuft of the distal phalanx. That made it the higher-complexity option when the terminal bone was also removed. Since 11752 is deleted, 11750 is now the primary active code for most permanent nail removal procedures. Operative documentation must support whichever code is selected.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 11752 covers excision of the nail and nail matrix for permanent removal, with amputation of the tuft of the distal phalanx. That bony component is what separates it from CPT 11750, which stops at the matrix. AAPC&#8217;s code lookup now lists 11752 as deleted, so it is a crosswalk decision rather than a [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":180960,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546,1103],"tags":[1364,4126,1602,1236,3372],"class_list":["post-180961","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","category-dermatology","tag-billing","tag-cpt","tag-cpt-modifiers","tag-medicare-reimbursement","tag-podiatry-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 11752: Nail and nail matrix excision billing guide<\/title>\n<meta name=\"description\" content=\"CPT 11752 is deleted. Use 11750 for matrix excision; 28124 or 28160 may apply if the distal phalanx tuft was excised.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11752\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 11752: Nail and nail matrix excision billing guide\" \/>\n<meta property=\"og:description\" content=\"CPT 11752 is deleted. 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