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Tag Archives: amputation

RT below-knee amputation stump wound/ulcer skin procedure

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In need of some skin wound expertise help, trying to make sure the correct codes are being captured based on the documentation, coworker and I feel the closes to this would be CPT code 11042/15999, I would really appreciate your help :)

PREOPERATIVE DIAGNOSIS:
Right below-knee amputation stump ulcer.
POSTOPERATIVE DIAGNOSIS:
Right below-knee amputation stump ulcer.
PROCEDURE PERFORMED:
Right below-knee amputation stump wound revision.
ANESTHESIA:
General with Dr. English.
ESTIMATED BLOOD LOSS:
5 cc.
FINDINGS:
Benign-appearing ulcer at the BKA stump. It was excised, debrided, and closed
primarily.
DETAILS OF THE PROCEDURE:
The patient is a 68-year-old female with prior below-knee amputation, developed
a necrotic wound and ulcer. She was consented for surgery, brought to OR in
supine position, sedated, and intubated without complication. Time-out per
protocol. Preoperative antibiotics given. The right BKA stump was prepped and
draped in the usual sterile fashion. A sharp dissection was used to excise the
tissue around that area and debrided down to healthy bleeding normal tissue.
Then, I proceeded to excise the ulcer itself and down to subcu and muscle and
fat were well-perfused tissue. Then, the wound was widened to create an
ellipse and close primarily with 2-0 nylon in an interrupted fashion. The
patient tolerated the procedure well, and she was extubated and returned to
PACU with vital signs stable.

Medical Billing and Coding Forum

Suturing of skin following amputation

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So this is a new one for me. We had a patient come in immediately following an amputation of his thumb by a power tool. The amputation was complete and my physician sutured the skin together to "close the amputation site." Patient did not want his amputated part re-attached. Thoughts on how to properly bill the work my physician did?

HPI:
*
Patient is a 62 year old male here after cutting off part of thumb.
*
Left thumb amputation
– was cutting fire wood this morning with large axe
– leg bumped the handle and it chopped his left thumb off
– finished feeding the animals
– found thumb in snow, put it in bag with ice
– lives an hour out of town in Imnaha
– put some towels on it
– can still feel everything and move thumb around
– does sculpt, make handmade saddles
– right handed
*
Review of Systems
Constitutional: Negative for chills and fever.
Neurological: Negative for dizziness and tingling.
*
Patient Active Problem List
Diagnosis
• Ankylosing spondylitis of multiple sites in spine (HCC-CMS)
*
Current Outpatient Prescriptions
Medication Sig Dispense Refill
• cephalexin (KEFLEX) 500 mg capsule Take 1 Cap by mouth 4 (four) times daily for 5 days 20 Cap 0
• oxyCODONE-acetaminophen (PERCOCET) 5-325 mg per tablet Take 1 Tab by mouth every 8 (eight) hours as needed for pain 15 Tab 0
• prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension Place 1 Drop into the right eye 4 (four) times daily 10 mL 2
*
Current Facility-Administered Medications
Medication Dose Route Frequency Provider Last Rate Last Dose
• cefTRIAXone 1 g injection 1 g intramuscular Once Katie Putnam, MD

*
*
Objective

*
Vitals
Vitals:
* 02/19/19 0820
Pulse: 76
SpO2: 95%
Weight: 202 lb (91.6 kg)
Height: 6′ (1.829 m)

Last 3 Vitals
Office Visit from 2/19/2019
Temp — 97.7 °F (36.5 °C) 98 °F (36.7 °C)
Pulse 76 75 56
BP — — 147/76
Resp — 16 14
Weight 202 lb (91.6 kg) 196 lb (88.9 kg) 189 lb (85.7 kg)
*

Estimated body mass index is 27.4 kg/m² as calculated from the following:
Height as of this encounter: 6′ (1.829 m).
Weight as of this encounter: 202 lb (91.6 kg).
Facility age limit for growth percentiles is 20 years.
*
Physical Exam
Constitutional: He is oriented to person, place, and time. He appears well-developed and well-nourished. No distress.
Talking, making jokes.
HENT:
Head: Normocephalic and atraumatic.
Eyes: Conjunctivae and EOM are normal.
Neck: Neck supple.
Cardiovascular: Intact distal pulses.
Pulmonary/Chest: Effort normal.
Musculoskeletal: Normal range of motion.
L thumb: Traumatic amputation distal of IP joint. Extensor and flexor mechanisms in tact. Approximately 10% of the base of the thumb nail present. There is a small, arterial bleed near the palmar aspect of the thumb. Bone present underneath macerated tissue, some oozing from bone. Sensation appears to be in tact.
Neurological: He is alert and oriented to person, place, and time.
Skin: Skin is warm and dry.
Psychiatric: He has a normal mood and affect. His behavior is normal. Judgment and thought content normal.

Procedure: amputation repair / partial closure:
Anesthesia with 6 mL of 1% Lidocaine without Epinephrine used for digital block of L thumb. Wound cleansed, upon examination the wound probed to bone. 6-0 vicryl was used to place a single figure-of-eight suture at the site of a small arterial bleed, good hemostasis was achieved. There was continued oozing from the bone, so 4-0 vicryl and 3-0 ethilon were used to gently reapproximate the overlying skin; good hemostasis was achieved. Antibiotic ointment, xeroform dressing and gauze was used and the wound was wrapped with overlying coban. Wound care instructions provided. Single ceftriaxone shot was administered. Observe for any signs of infection or other problems. Return for wound examination in 1 day. Return for suture removal in 7 days.

Assessment and Plan: Patient is a 62 year old male here for finger amputation.
*
1. Traumatic amputation of left thumb, initial encounter
2. Contact with workbench tool, initial encounter
3. Need for diphtheria-tetanus-pertussis (Tdap) vaccine
Traumatic amputation of the left thumb due to axe injury. Flexor and extensor function in tact. Wound cleansed and repair with gentle reapproximation of tissue as above. Discussed with orthopedic team in ***who stated that replant was a possible option but may be unsuccessful given time of injury. Patient declined to go to *** for evaluation. Good hemostasis was achieved with the repair, wound dressed with plan for check-up tomorrow. Recommending that patient be seen by orthopedic team in *** this week or next week; patient reluctant given concerns about transportation in winter weather. Will emphasize this recommendation again tomorrow. CTX and TDAP given today. Small rx for oxycodone-acetaminophen given as patient unable to take NSAIDs.
– IMMUNIZATION ADMIN
– TDAP (7 + YEARS)
– INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
– cephalexin (KEFLEX) 500 mg capsule; Take 1 Cap by mouth 4 (four) times daily for 5 days Dispense: 20 Cap; Refill: 0
– cefTRIAXone 1 g injection; Inject 1 g into the muscle once

Medical Billing and Coding Forum

Amputation left hallux stump

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Needing help with the appropriate CPT for procedure: Amputation of left hallux stump

Patient had a partial amputation in same area years ago but has recurrent ulcerations.

Procedure: Two semi-elliptical incisions were created around the base just distal to the base of the hallux first MPJ and full thickness incisions were created down to bone with 15 blade. Toe was disarticulated and the extensor and flexor tendons were identified, protracted and cut… all devitalized tissues were debrided from the wound…bleeders clamped…

CPT 28810? Also diagnosis T87.44 along with the E11.621 ?

TIA
KAM

Medical Billing and Coding Forum

Finger amputation CPT code

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Can someone please confirm that CPT 26951 is the correct code for the following procedure?
Preop DX: Traumatic amputation, right index finger with fracture through the distal phalangeal physis.
Procedure: Patient was taken to the op room and placed on the table.The right upper extremity was sterilely prepped and draped after the administration of the general anesthetic. The finger tip was then examined. Upon initial presentation in the ER dept. The finger tip was rotated by 180 degrees with a nail on the volar surface. This was reduced in the ER and upon exam under anesthesia, it is apparent that the only remaining attachmentis the flexor tendon. There was no soft tissue attachment whatsoever and no perfusion obviously of the tip of the finger. The decision was therefore made to complete the amputation by transecting the flexor tendon and then using the skin from the tip as graft in order to cover exposed bone and preserve as much length as possible. The nail was removed with an tiris scissors and then the nail bed and remainder of the distal phalanx was then dissected free. The subcutaneous tissues were dissected off of the skin and dermis. This was then placed over the tip of the finder. There was no contamination whatsoever. The nail had been avulsed from the tip and there was a small amount of germinal matrix appearing tissue on the ulnar side of the finger tip. This was removed with a scalpel. The graft was then sutured with 4-0 chromic suture. An initial dorsal stay suture was placed and then further stitches were placed around the circumference with the skin being trimmed as necessary to provide good coverage without any tension and without creating a pocket for hematoma formation. There was capillary bleeding from the distal tip of the finger, but this was minimal. The coverage was quite good. The fingers and hand was then cleaned with saline. A metacarpal block was done with .25% marcaine. A sterile dressing of Xeroform and two gauze was then applied which was tied around the wrist and then this was covered with Coban. Pt doing well transferred to postop for recovery.

Did an amputation of the bone in the finger happen? I do not read where any part of the bone was cut. I see where the bone was covered, but no bone was cut out.
What do you think, correct CPT code or if not any suggestions? Thank you.

Medical Billing and Coding Forum

Post Toe Amputation Metatarsal Removal

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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.

Medical Billing and Coding Forum

toe amputation with melanoma

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How would you code this procedure and why? I am looking only for CPT code(s) you would use and explanation of why you chose the code(s):

Plantar melanoma of the lateral most aspect of the RT 5th toe near the ball of the foot. It extends laterally and up onto the dorsum of the foot as well as onto the lateral inferior and superior aspects and lateral aspects of the right fifth toe. Presenting for wide excision.

Procedure:

A 1cm measured margin was taken in all directions around the pigmented portion of the melanoma with the exception of the toe. When I measured 1cm margin there, the entirety of the skin of the toe would have needed to be excised. So, after consultation with the plastic surgeons, we elected to excise the entire toe to diminish the risk of local recurrence, so an incision was made longitudinally between the fourth and fifth toe. The incision was extended down into the plantar surface of the foot, staying away from the pigmented portion of the lesion. This was brought to the mid foot laterally and extended up on to the dorsum of the foot and carried down forward to join with the original incision between the toes. The dissection was then carried down between the toes. The digital vessels going to the fifth toe were identified, clamped proximally, divided and then ligated with 4-0 vicryl suture. The metatarsophalangeal joint was then opened through the capsule, the entire metatarsal was saved, but the distal phalanx was disarticulated. The extensor tendon was incised as was the flexor tendon during this process and the toe was amputated, removed en bloc with the skin specimen. With removal, the size of the excision was 7X7cm. Some of the fat pad on the plantar surface of the lateral aspect of the foot was then mobilized and sutured in place to the tissue on the dorsum of the foot covering the entire end of the 5th metatarsal. At this point, the wound was irrigated, hemostasis achieved and plastic surgeon cam in to perform the first portion of the reconstruction of the foot.

Medical Billing and Coding Forum