Amputations 5 Days Apart


Williamsport, PA
Best answers
I need some help coding these two procedures. The patient had a guillotine amputation of the left foot, followed by amputation of the left leg 5 days later. I found CPT code 27882-LT for the first amputation, but I'm questioning whether I can use that since the entire leg was not amputated at that time. How would you bill these?

Procedure One:
Procedure Details
Guillotine amputation of left foot
Patient was laid supine on the operating table and satisfactory timeout was accomplished. Sterile prep and drape of the left lower extremity was accomplished. Transverse incision was made in the distal forefoot just above the ankle where she had previously had plate and screws of an ankle fracture using a 15 blade. Incision was circumferential. Dissection was carried down through the subcutaneous tissue ligation of large veins and small bleeding points was accomplished with 2-0 and 0 Vicryl. Oscillating saw was then used to transect the tibia and the fibula. The anterior tibial artery posterior tibial artery and peroneal artery were ligated with 0 Vicryl remainder of the muscle and tendinous insertions were divided using electrocautery. Bleeding points were controlled with electrocautery there were minimal. There was no obvious abscess purulence or drainage encountered and therefore no cultures were obtained. Following this Xerofoam dressing Kling fluff 4 inch Kling and 4 inch Ace wrap were applied. The patient tolerated the procedure well. She was extubated from her LMA and was taken to recovery room in stable condition.

Procedure Two:
Following satisfactory place the patient supine the operating table satisfactory timeout was accomplished IV antibiotics and DVT prophylaxis being utilized the patient had previously undergone guillotine amputation of the left foot and as such sterile prep and drape of the left lower extremity was accomplished in a sterile glove and Coban was placed over the distal aspect of the prior amputation site in the distal leg. Marking pen was then used to trace a transverse incision 4 fingerbreadths distal from the tibial tuberosity. Longitudinal extension along the medial and lateral calf and then a then a transverse incision on the posterior calf approximately 10 cm distal to the proximal transverse incision was accomplished. #10 blade was then utilized to incise the skin. Electrocautery was used to transect down through the muscle groups medial and lateral to the tibia the tibia was then completely dissected being careful not to injure the posterior tibial artery and popliteal trifurcation. Tibia was then transected with oscillating saw no bleeding occurred. The fibula was then dissected and transected with oscillating saw. We were careful not to injure the peroneal vessels behind the fibula. The trifurcation vessels in the calf were then isolated and ligated individually with the 0 Vicryl no bleeding occurred. Muscle groups were then sequentially transected using electrocautery and nerves were ligated and divided with 0 Vicryl. The remainder of the posterior gastroc and soleus muscle groups were transected with fillet knife. A 4 leg was then taken off the field. The end of the tibia was angulated with the saw to prevent any sharp edges and a rasp was used. The fibula was transected with rongeur bone cutters to be about a centimeter more proximal than the tibia and was also rasped. Minimal muscular bleeders were then ligated with 2-0 Vicryl and electrocautery where indicated and the muscle was trimmed appropriately. The posterior muscle flap was then folded over the tibia and fibula and secured with figure-of-eight of 0 Vicryl to the fascia. 2 oh Vicryls were used in between the 0 Vicryls to further involuted fascia where indicated. The posterior muscle flap looked appropriate and did not require any trimming. The area was copiously irrigated with saline and little bit of peroxide. And then the skin was closed with clips. Vaseline gauze or Adaptic fluff dressing ABDs Kling and Ace wrap were applied patient tolerated the procedure well and was transported to recovery room in stable condition extubated from her LMA

Thank you in advance for any help!!