Avulsion of Nails and Treatment of Ingrown Nails

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
November 2nd, 2016

  1. Subungual abscess

  2. Contusion of the nail

  3. Crushing injury of the toe or finger

  4. Painful onychauxis

  5. Painful onychomycosis

  6. Onychocryptosis (ingrown nail)
    1. Onychocryptosis occurs most frequently in the big toes. The condition is categorized into:
      1. Simple onychocryptosis
      2. Complicated onychocryptosis
    2. The simple or uncomplicated category is caused by pressure on the nail groove by an essentially healthy nail caused by injudicious cutting of the nail or by trauma from improperly fitting shoes. 

    3. Complicated onychocryptosis, on the other hand, varies from deep ulceration in the groove to profuse granulation, infections, and distortion of the nail plate. A covered service is usually a disease of a younger age group of patients.

Limitations
  1. Treatment of simple onychocryptosis with removal of the offending wing or spicule of the toenail is considered as trimming/cutting of the nail and is covered only when a systemic/vascular condition is present under routine foot care guidelines.

  2. When performed properly and followed by instructions in the use of proper shoes and nail care, the problem of onychocryptosis does not recur. If there is a recurrence, it generally takes six months for the removed portion of the nail to grow and become ingrown. If the problem becomes chronic or recurrent, radical removal of the nail may be performed. 

  3. This Carrier would not expect 117301173211750, or 11765 to be routinely performed more than once in six months on the same nail or nail border.

  4. Cosmetic nail avulsion is not covered.

References:

Avulsion of Nails and Treatment of Ingrown Nails. (2016, November 2). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/avulsion-of-nails-and-treatment-of-ingrown-nails-31581.html

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