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!
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!