The doctor performed bilateral hallux nail avulsions, at first the doctor wanted to bill it as CPT 11730-TA and CPT 11730-T5-59, but this does not seem right, can you assist me in billing this correctly? This patient never had a problem before, so this case it is not a repeat nail avulsion issue.
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When performing a nail avulsion, the first nail avulsion is represented as CPT 11730-TA but the second and subsequent nail avulsion is CPT 11732-T5, in this question was a right and left hallux. There is NO PTP edits in the NCCI between these two codes, so Modifier 59 is not necessary unless a payer has stated in their medical billing policy to do so. CPT 11730 does have a bilateral indicator, so an insurance may require this to be billed on one line as CPT11730-50, make sure you double your fee if you are required to bill it this way.