Amputation coding with another procedure

tionna

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HOWDY :) ..I have a question regarding coding for a amputation of the MPJ and the distal tip of the metatarsal (not complete), would i code it 28820 ( amp toe MPJ) AND add 28122 ( partial excision met)? We currently bill as 28810 (amputation met with toe), However doctor feels as though this maybe incorrect. Please help, thank you! :eek: :eek:
 

acf7575

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CPT 28810 is excising the metatarsal and the attached toe from the tarsometatasal joint.
"28810 Amputation, metatarsal, with toe, single" - "The physician performs an amputation of a metatarsal bone and its attached toe. An incision is made dorsally over the involved metatarsal and toe. This is carried deep to the tarsometatarsal joint. The joint and capsule are identified. A capsulotomy is performed and the metatarsal is disarticulated from the other toes. The incision is continued around the toe itself. Tendons are retracted or removed as indicated. The metatarsal bone and the toe are completely dissected free from the foot and removed. The wound is irrigated and debrided. It is closed in layers. A dressing and a cast or a brace are applied." (CDR info from 3M Coding Reference)
If the provider is only taking the tip of the metatarsal 28810 would not be correct since he is not taking the whole metatarsal bone.

28122 (Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus) is a CCI bundle with 28820 (Amputation, toe; metatarsophalangeal joint).

If they are of the same digit being removed, I would expect that you could not use modifier 59, it would need to be a different digit.
 
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