The Codes
- 11719: trimming of non-dystrophic nails, any number
- G0127: trimming of dystrophic nails, any number
- 11720: debridement of nails by any method, one to five
- 11721: debridement of nails by any method, six or more
Trimming Versus Debridement
Trimming shortens the nail. Debridement reduces the thickness and removes diseased nail material, typically for mycotic or dystrophic nails. The note should describe the nails treated, the condition of each (thickness, discoloration, subungual debris), and what was done.
Medicare Coverage For Mycotic Nails
Debridement of mycotic nails is covered when the physician documents mycosis or dystrophy and the patient has clinical symptoms. For an ambulatory patient, that means marked limitation of ambulation, pain, or secondary infection. For a non-ambulatory patient, pain or secondary infection. Without those findings, the care is treated as routine foot care and needs the systemic condition and class findings to be covered.
Billing Nail Care With Other Services
Nail debridement can be billed with paring of corns or calluses when both are documented and covered. Watch NCCI edits for combinations that require a modifier and confirm that each service has its own documented medical necessity.
Frequently Asked Questions
- Is 11721 billed once per foot?
- No. 11720 and 11721 are reported once per encounter based on the total number of nails debrided across both feet.
- How often can mycotic nails be debrided?
- Many MAC policies allow routine nail care about every 61 days unless the record documents a need for more frequent treatment.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.