Our practice had a patient who we performed a RT great toe transmetatarsal amputation. About 2 months later the patient returns with osteomyelitis of the second toe and remaining metatarsal bone of the great toe. We are not sure how to code the removal of the remaining metatarsal bone. Any advice would be greatly appreciated. Also any documentation to support the codes would be great too if possible. Our Docs love documentation . Thank you.

Procedure(s): Right second toe amputation including the entire second metatarsal bone and removal of the remainder of the first metatarsal bone of the right foot
*
The patient was placed on the operating table in supine position and underwent successful general endotracheal anesthesia. Timeout was called to verify the operation to perform was the second right toe transmetatarsal amputation with debridement of wound . The right foot was then prepped in its entirety including the lower portion of the leg to the mid calf area with ChloraPrep and sterilely draped. A circumferential incision made around the base of right second toe and carried on down to the MP joint space and which time it was disarticulated at the joint space and removed from the operative field. Using the periosteal elevators the second metatarsal bone was then dissected free of surrounding tissues back to the cuneiform bone and it was then disarticulated at its joint space with the osteotome and removed removed from the operative field. Hemostasis controlled with the Bovie cautery and there was brisk leading in the entire wound. The residual portion of the first metatarsal bone from the prior transmetatarsal amputation right great toe was then dissected free from the surrounding tissues and was disarticulated from the cuneiform bone and it was removed the operative field. The articular surfaces of the cuneiform bones were then rongeured back to cancellous bone to remove the cartilaginous portions. After this been accomplished the open wound was then irrigated with 3 L of bacitracin solution using the Pulsavac irrigating system. Further hemostasis controlled with Bovie cautery and then the wound was packed open using orthopedic solution soaked Kerlix packed into the wound and then dry 4 x 4’s between the toes and the entire dressing was wrapped with Curlex with #8 Spandage tube net dressing to hold the Kerlix bandage in place. The sponge and needle count were correct ×2 . The blood loss was approximately 200 mL’s. The necrotic tissue surrounding the MP joint space was sent for aerobic and anaerobic cultures fungal smear and culture and AFB smear and culture. The residual portion of the first metatarsal bone as well as the second metatarsal bone was sent for pathological identification as well as the second toe.