CPT 11740Surgery

Drain blood from under nail

CPT code 11740 is used when a healthcare provider drains trapped blood from underneath a fingernail or toenail, typically after an injury like slamming a finger in a door or dropping something heavy on a toe. The provider creates a small hole in the nail to release the accumulated blood and relieve pressure and pain.

Showing rates for

National Average

Base Medicare rate

$55.96

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.37

PE RVU (NF)

1.33

MP RVU

0.03

Total RVU

1.73

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always bill modifier 25 when performed during an E/M visit if you documented a separate evaluation beyond the decision to perform the drainage. The E/M should address the injury assessment, examination of other areas, or unrelated conditions.
Impact: Can increase total reimbursement from $55.96 to $130-$205 depending on E/M level. Approximately 65% of 11740 claims should include a separately billable E/M with modifier 25.
Bill in non-facility setting (office/clinic) rather than facility setting when possible to capture the higher $55.96 rate versus $32.02 facility rate.
Impact: Increases reimbursement by $23.94 (74% higher) per procedure. Choose the appropriate place of service code (11 for office, 22 for outpatient hospital) accurately.
When draining multiple digits, append modifier 59 or XS to the second and subsequent procedures with strong documentation showing separate sites and medical necessity for each.
Impact: Additional procedures typically reimburse at 50% or $28.00 each. Without proper modifier, subsequent procedures will be denied as duplicates, losing $28+ per additional digit.
Document the percentage of nail surface covered by hematoma and specific pain level. Medicare and commercial payers may deny if hematoma involves less than 25% of nail surface as this may not meet medical necessity.
Impact: Prevents denials that result in $0 reimbursement. Claims with documented >50% nail involvement and severe pain (7+ on pain scale) have 15-20% lower denial rates.
Specify the exact technique used (thermal cautery, electrocautery, or needle/drill) and document immediate pain relief in your procedure note. This strengthens medical necessity and differentiates from spontaneous drainage.
Impact: Reduces audit risk and supports medical necessity. Proper documentation decreases post-payment review requests by approximately 30% and strengthens appeals if denied.

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Common denials

Bundled with E/M service - payer considers the drainage included in the evaluation and management service without modifier 25 or documentation doesn't support separate E/M.

How to appeal: Submit appeal with documentation clearly highlighting the separate E/M components: history of injury, examination of affected digit and surrounding areas, decision-making process. Include modifier 25 on corrected claim. Quote CPT guidelines stating minor procedures don't include comprehensive evaluation. Success rate increases with documentation showing E/M addressed concerns beyond the immediate drainage need.

Medical necessity not established - hematoma too small or insufficient documentation of pain/pressure symptoms requiring intervention.

How to appeal: Provide clinical notes documenting hematoma size (percentage of nail surface involved, ideally >25-50%), pain scale rating (typically 7+ out of 10), patient's inability to function, and failed conservative management if applicable. Include before/after photos if available. Reference literature showing subungual hematomas involving >25% of nail benefit from drainage. Cite patient relief of symptoms post-procedure.

Duplicate claim denial when multiple digits treated - second and subsequent procedures denied without proper modifiers (59, XS, or anatomic modifiers).

How to appeal: Resubmit with appropriate modifiers (59 or XS) on lines 2+ and detailed documentation showing separate digits were treated. Include anatomical diagrams or clear notation (e.g., 'right index finger' and 'right thumb'). Reference CPT guidelines allowing separate reporting for distinct anatomic sites. Some payers require modifier RT/LT in combination with 59/XS.

Invalid or non-specific diagnosis code - missing laterality, incorrect encounter type (initial vs. subsequent), or using unspecified codes like S69.90XA instead of digit-specific codes.

How to appeal: Submit corrected claim with appropriate ICD-10 code specifying exact digit, laterality, and encounter type (typically 'A' for initial). For finger: S60.10XA-S60.19XA series; for toe: S90.211A-S90.229A series. Include clinical documentation supporting the specific diagnosis. Most payers will process corrected claim within 30 days when only coding error is present.

Frequently asked questions

What is the CPT code 11740 used for?

CPT code 11740 is used to bill for the drainage of blood trapped beneath a fingernail or toenail (subungual hematoma evacuation). This procedure involves creating a small hole in the nail plate to release accumulated blood and relieve painful pressure, typically following crush injuries or trauma to the digit.

How much does Medicare pay for CPT 11740 in 2025?

In 2025, Medicare pays $55.96 for CPT 11740 when performed in a non-facility setting (office/clinic) and $32.02 when performed in a facility setting (hospital outpatient). The total RVU value is 1.73 (work RVU 0.37, non-facility PE RVU 1.33, facility PE RVU 0.59, MP RVU 0.03) multiplied by the 2025 conversion factor of 32.3465.

Can I bill an E/M visit with CPT 11740 on the same day?

Yes, you can bill an E/M visit with CPT 11740 on the same day using modifier 25 on the E/M code, but only if the E/M service is significant and separately identifiable from the procedure. Your documentation must clearly show the E/M addressed aspects beyond the typical evaluation included in deciding to drain the hematoma, such as evaluating the injury mechanism, assessing for fracture, examining other injured areas, or addressing unrelated conditions.

What diagnosis codes are appropriate for CPT 11740?

Appropriate ICD-10 codes include subungual hematoma codes from the S60 series for fingers (S60.10XA-S60.19XA for contusion of unspecified/specific fingers) and S90 series for toes (S90.211A-S90.229A for contusion of specific toes). You must include laterality (right/left), specific digit when documented, and the appropriate seventh character 'A' for initial encounter. Using unspecified codes or missing laterality often results in claim denials.

How do I bill CPT 11740 for multiple digits?

When draining hematomas on multiple separate digits, bill 11740 for the first digit without a modifier, then add modifier 59 (or XS for separate anatomic site) to each subsequent line item for additional digits. Document each digit specifically with laterality and medical necessity for each. Most payers reimburse the second and subsequent procedures at 50% of the allowed amount ($28.00 for Medicare non-facility), though some may pay full rate with proper modifiers.

What is the global period for CPT 11740?

CPT 11740 has a 0-day global period, meaning there are no bundled post-procedure follow-up days included in the reimbursement. Any follow-up visits for complications or ongoing care can be billed separately with appropriate E/M codes and documentation. This makes the procedure straightforward for billing purposes with no global period considerations.

Does CPT 11740 require special documentation for medical necessity?

Yes, medical necessity documentation should include the hematoma size (ideally >25% of nail surface area), significant pain level (typically 7+ on a 0-10 scale), mechanism and timing of injury, and functional impairment. Payers may deny claims for very small hematomas that don't cause significant symptoms. Document immediate pain relief following drainage to support the necessity of intervention versus conservative observation.