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Onychauxic Dystrophic Toenails Requiring Debridement in Medicare Patients

Prevalence and Anatomical Distribution

Seymour C. Frank, DPM^* and Helene L. Freer, DPM, MPH

^* St Vincent Catholic Medical Centers, Brooklyn/Queens Region, Jamaica, NY.
St Luke’s Hospital, Newburgh, NY.

Corresponding author: Seymour C. Frank, DPM, 3 Pheasant Trail, Coram, NY 11727.

Abstract

Six hundred twenty-nine Medicare patients were evaluated for the presence of onychauxic toenails that in the judgment of the examiners required reduction. Forty-two percent of this group had five or fewer toenails requiring reduction and 24.3% had six or more toenails requiring reduction. Statistics reported by a regional Medicare-contracted carrier for the years 1997 to 1999 showed that 95% of claims submitted for nail debridement were for six or more nails and 5% were for five or fewer nails. The 1999 Medicare Part B data listed the top 300 Current Procedural Terminology (CPT) foot-care codes in order of utilization. Code 11721 (debridement of six or more nails) was number one. National statistics from the Health Care Financing Administration in 1999 indicated approximately a 5:1 ratio in favor of CPT code 11721 (six or more nails). In contrast, this study found a ratio of 2:1 in favor of CPT code 11720 (five or fewer nails). (J Am Podiatr Med Assoc 93(5): 388-391, 2003)