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Tag Archives: amputation

Distal Amputation third toe right foot

Posted on by
Good Morning,

Hoping I can get some help on both ICD-10 Diagnosis and CPT on this one. Thanks in advance

Patient has Chronic Ulceration with Osteomyelitis thrid toe right foot (L97519;L03031;M86171)

Procedure: Attention was directed to the distal aspect of the patient’s third toe right foot where an
incision was placed circumscribing the toe just distal to the distal interphalangeal
joint. The incision was deepened down to bone. The distal interphalangeal joint was
identified and the toe was disarticulated at this joint. The distal aspect of the toe was
then excised in total and sent to Pathology for further inspection. Aerobic and anaerobic
cultures were then taken from the joint. The head of the middle phalanx was resected
using power instrumentation. The middle phalanx appeared to be healthy. The bone was
hard and white. No drainage was noted. The remaining portion of the middle phalanx was
rasped smooth. The surgical site was thoroughly irrigated with sterile saline. The deep
structures were closed wit h 3-0 Vicryl and the skin was closed with 4-0 Prolene. Sterile
compressive dressings were then applied. At this time, the tourniquet was released and
intravenous sedation was discontinued.

I am looking at 28825 with Modifier T7

Medical Billing and Coding Forum

Toe amputation to tarsal bone

Posted on by
I need help with this procedure. The doctor removed the right great toe at the DIP joint, then removed the metatarsal head. She also removed the cuneiform bone below the toe. I’m not sure how to code the last part. I want to use 28810 for amputation of the metatarsal with a toe because it sounds like the surgeon removed both, but I’m not too sure. I also want to report the debridement of the right foot because, from pictures, it looks like it’s much more than the toe.
Here’s the report:
She was taken to the operating room on yesterday after her thrombocytopenia, leukopenia, anemia had been reversed. She is placed on supine position on the operating room table and after adequate general anesthesia was obtained the right foot was prepped and draped in a standard surgical fashion. An elliptical incision was made with a 15 blade scalpel around the great toe on the right side extending all the way down the lateral part of the right foot and across the dorsum of the right foot to include all the areas of necrosis and wet gangrene. The incision was carried down through the subcutaneous tissue to the bone. The right great toe fell off at the DIP joint because of the gangrene and osteomyelitis. This was sent for pathology. The metatarsal head was also not viable and it was removed also. When I got down to the cuneiform bones, these did appear viable, I did take out the cuneiform bone beneath the right great toe. After this was accomplished, I did an excisional debridement with a 15 blade scalpel to remove all the dead necrotic tissue that was present along the lateral edge of the right foot and on the dorsum of the right foot. The wound was then irrigated with a Pulsavac. Deep cultures were obtained. At the end of the procedure I had removed all the necrotic tissue and bone down to pink healthy tissue. The problem is this is not going to be a viable amputation. At this point even a transmetatarsal amputation would not be a viable amputation because I had to go so far back on the dorsum of the foot to remove all the necrotic skin and subcutaneous tissue. Will most likely need a below the knee amputation in the future when she is more medically stable from her lip from her leukemia standpoint. After hemostasis was adequate I did place a wound VAC 125 mm suction. She did tolerate the procedure well she was extubated in the OR and transferred back to the ICU in stable condition.
Thanks!

Medical Billing and Coding Forum

CPT code for one Toe Amputation submitted in two vials

Posted on by
Hello everyone!
We received a toe amputation in two vials – do we have to bundle these as one "Toe, nontraumatic amputation" (which it was non-traumatic) as one 88305 because they are both parts from the same toe or can they be coded as "88305" for part 1 and "88304" for part 2?

1. Great toe, right, amputation:
– Ulcers with acute inflammation and necrosis of skin and soft tissue with underlying acute osteomyelitis.

2. Great toe, right, bone left behind, amputation:
– Bone with no significant inflammation.
– Synovium with nonspecific reactive changes including increased vascularity and villous hyperplasia.

And I have included the email to the CPT group below for more clarity – what are everyone’s thoughts on this?

"I’m not sure what to do here. I understand why a 304 seems reasonable – I’m assuming you are sort of treating it like a colon donut from a non-tumor case that would come in its own container. I can’t find any documentation to suggest this policy is applicable to toe amputations though.

Another option would be to code the 2nd part as a Bone, Biopsy/Curettings (88307). It certainly isn’t fragments, exostosis or a resection (or any other category of bone that is listed).

After reading through the toe amputation section, it makes it clear that you can bill for each toe separately, regardless of how many containers they come in (assuming individually identifiable), but it doesn’t address the issue of a single toe coming in multiple containers or with additional margins at all.

Anyone else have thoughts on 3 options:
88305 x 1 because it is a single toe
88305 + 88307 (toe + bone biopsy)
88305 + 88304 (toe + we are making an educated guess about appropriate code based on other organ system)"

Medical Billing and Coding Forum

amputation

Posted on by
Could I get some opinions on this one, please? "Attention was then directed to the left great toe, where a full-thickness incision made just proximal to the first metatarsophalangeal joint. A sagittal saw was then used to resect the distal first metatarsal. The great toe and distal first metatarsal were then dissected free. " This was the entire surgery.
He did not disarticulate the toe (28820), nor the metatarsal (28810). What about 28122?

Appreciate any help :-)

Medical Billing and Coding Forum

Metatarsal Head Resection VS. Amputation

Posted on by
Can someone take a look at this report? The doctor picked an amputation code for this procedure, then states he only excised the metatarsal head. Thanks!

Following satisfactory placement of the patient supine on the operating table satisfactory timeout was accomplished, satisfactory general anesthesia was induced by Dr. taken, and sterile prep and drape of the left lower extremity was accomplished. The left first metatarsal head had osteomyelitis and an underlying plantar ulcer. As such a 3-1/2 cm longitudinal incision was made with a 15 blade overlying the metatarsal head and distal shaft of the metatarsal. The incision was carried down through the subcutaneous tissues down onto the metatarsal shaft and carried through to the metatarsal head. Dissection proceeded to free up the metatarsal and then a micro-oscillating saw was used to transect the metatarsal shaft at the distal third. Once transected the metatarsal shaft was grasped with a towel clip was a brittle bone and it splintered. But with a grasping elevation was accomplished away from the underlying soft tissues in the plantar surface along with tenderness insertions and these were debrided and excised the sesamoid bone was also identified and excised. The metatarsal head was separated from the proximal great toe at the joint space. The proximal area of the first metatarsal shaft was sent for culture and the metatarsal head was sent for culture and pathologic examination. The sesamoid bone was also sent for culture and for pathologic examination. Following this the surgical bed was irrigated with saline and then closed with 3-0 Monocryl for the subcutaneous tissue after satisfactory hemostasis and the skin was closed with interrupted 4-0 Prolene sutures. Sterile dressing Kling and Ace wrap was applied. Patient tolerated procedure well was taken to recovery room in stable condition.

Medical Billing and Coding Forum

please help toe amputation

Posted on by
Need someone to look at this .

POSTOPERATIVE DIAGNOSIS: Ischemic necrosis of the tip of the left fourth toe.

PROCEDURE PERFORMED: Amputation of the distal portion of the left fourth toe at the base of toenail.

PROCEDURE IN DETAIL: Following informed consent, the patient was brought to the Operating Room and remained on the operative roller. Following induction of intravenous sedation, the foot was prepped and draped. Local anesthetic is infiltrated in a regional block. A#15 blade was used to excise the distal portion of the left fourth toe, which is nonviable. This is easily removed. No open wound is present as this was in the process of toe amputating. Irrigation of antibiotic solution is followed by dressing the toe and the patient was moved from the Operating Room to Recovery in good condition.

Any thoughts or ideas on how to code this procedure?

Thank you in advance for all your help and time with this matter.

Medical Billing and Coding | AAPC Forum