Practicode Amputation Question

[Allysaloop]

Hello again! I accidentally closed this case before being able to ask a couple questions, and was wondering if anyone is willing to help me out? Does the amputation described here code to 28820 or 28810? 28810 describes the removal of a metatarsal bone, but I can't see that in the documentation even though that is Practicode's listed answer. Also, although the accepted diagnosis code is L97.419 for a Non-pressure chronic ulcer of right heel and midfoot with unspecified severity, the rationale for the post coded answer states,"The debridement went into the subcutaneous tissue but the body of the operative note states there were no exposed structures." The part of the note that mentions subcutaneous appears to be the Left foot where the amputation was performed, not the debridement. Is "no exposed structures" enough to code 11042, or is that code the best option for the unspecified severity of the ulcer? I've got myself all twisted up on this one! Thank you in advance for untangling

OPERATIVE NOTE

Orthopedic Group General

SEX: F AGE: 55

Date of Service: 1/1/20XX
PREOPERATIVE DIAGNOSIS: Diabetic feet with a necrotic left fifth toe and a plantar ulcer of the right foot.

POSTOPERATIVE DIAGNOSIS: Same.

NAME OF PROCEDURE: Irrigation and debridement of a diabetic ulcer on the right foot and amputation of the left fifth toe.

SURGEON: Brandon Andrews, MD

ANESTHESIA: General

INDICATIONS: The patient is a female who comes in with untreated diabetes. She has longstanding necrosis and draining pus from the fifth toe on the left foot and a draining ulcer in the center of the plantar surfaces of the right foot. Therefore, surgical debridement is warranted.

DESCRIPTION OF PROCEDURE: The patient was brought into the operating room. Under general anesthetic, she was prepped and draped and prepped in the usual sterile fashion. The right foot was addressed first. The callus surrounding the ulcer is removed using scissors. The necrotic tissue overlying the ulcer is removed by first cutting around the intact skin with a #15 knife blade. We then used a curette to clean the area, removed necrotic tissue from the depth of the wound. There were no exposed structures. The wound is irrigated with 3 L of sterile saline solution. Antibiotic beads are placed in the wound. The wound is covered with a Tegaderm and a sterile dressing is applied. We then addressed the left foot. The tourniquet is inflated to 300 mmHg. We draw out a racquet-type incision, incised the skin and subcutaneous tissue all the way down to bone using a #15 knife blade. Due to osteomyelitis of the mid of the proximal phalanx, the toe was really not attached in any way. The toe is now removed the base of the phalanx is debrided away using a rongeur. The metacarpal head is left intact. We take cultures from the site. We irrigated with 3 L of sterile saline solution. The nerves are cut back. The tendons are cut back. The arteries are tied. Once that is done, the wound is closed using 3-0 nylon after placing antibiotic beads within the wound. Sterile dressing is applied. The patient tolerated this well. She will return to clinic for follow up in a few weeks.

Brandon Andrews, MD

Electronically signed by BRANDON ANDREWS, MD 1/1/20XX

 

[NRaizman]

The amputation is at the MTP level - 28820.

 

[Allysaloop]

The amputation is at the MTP level - 28820.

Dang it Practicode! Thank you so much for your reply, I was starting to think I was going crazy! I'll have to take the L on this one since I closed the case too fast, but I'm grateful to be validated. Take care!

 

[katysnorwood@gmail.com]

I used two different but similar cases and chat gpt to create this much similar to understand difference between the cpt codes.
“Due to osteomyelitis of the mid of the proximal phalanx, the toe was really not attached in any way. The toe is now removed the base of the phalanx is debrided away using a rongeur. The metacarpal head is left intact. “ M86.172 This means “other acute osteomyelitis”

CPT code 28810 involves the removal of a toe along with part or all of its corresponding metatarsal bone (a ray amputation). In contrast, CPT code 28820 is used for the removal of a toe only, stopping strictly at the metatarsophalangeal (MTP) joint without resecting the metatarsal shaft.

Key Differences in Procedure

• CPT 28810 (Ray Amputation):
  • Removes the digit and part/all of the metatarsal bone.
  • Used when disease, infection, or trauma affects the metatarsal shaft.
  • Associated with a 90-day global surgical period.
• CPT 28820 (Toe Amputation at MTP Joint):
  • Removes only the toe at the joint line.
  • Used when the metatarsal head and bone are healthy and left intact.
  • Associated with a 0-day global surgical period.