Wiki CPT code for one Toe Amputation submitted in two vials


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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)"
I'm interested to hear other opinions.

I would code this as both specimens bundled into 88305 for amputation. Specimen #2 indicates "bone left behind" but no suspicion of pathology. That is, it doesn't ask to r/o osteomyelitis or anything similar. It makes me wonder if the toe was just insufficiently amputated when specimen #1 was created. Does the clinical information provided give you any additional clues?

You could request the operative note if you want to pin down the surgeon's intention.
Thank you for your quick response! Yes we do have clinical info -

Nonhealing right great toe ulcer-underlying osteomyelitis
Post-op dx: Diabetic foot infection
Procedure: Right great toe amputation
Since it is submitted as two separate specimens, you should code it as two separate specimens.
Specimens 1 is the toe amputation whic is non traumatic .. no problem 88305
Specimen 2 - I would translate "bone left behind" as a bone fragment and code it to 88304
Thank you for your help! That's exactly what we had done but we weren't 100% sure about it as they really don't have anything in Paget's to explain this particular situation so that's why I reached out. :cool: