surgery coding help, please

solocoder

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I could really use some advice on how I can bill this surgery. The "debridements" I would code as 28122 and the amputation 28800. The 28122 is a component of 28800, but has more RVUs, so considered to be more work? Multiply that times 4, that is considerably more work (and RVUs) than the amputation. That makes it not seem right to only be able to bill the amputation. This is Medicare, by the way.

LIS FRANC'S AMPUTATION OF LEFT FOOT
Attention was directed to the dorsal aspect of his left foot, where a transverse incision was performed at the tarso-metatarsal joints, extending laterally into the base of the 5th metatarsal.* The primary incision was then lengthened at both ends distally and it was connected on the plantar aspect of the left forefoot.* The incisions were deepened in the same plane paying careful attention to preserve all the vessels and nerves which were retracted and cauterized as necessary.

By using a sharp dissection, periosteal structures were undermined from underlying bone from the tarso-metatarsal joints.* The forefoot was then amputated and passed off the table.* All the bleeders were ligated.* The areas were fully flushed with sterile saline solution.

DEBRIDEMENT OF CUNEIFORMS AND CUBOID, LEFT FOOT
Attention was directed to the distal aspects of the medial, intermediate, and lateral cuneiforms as well as cuboid, and by using a power saigttal saw and osteotome and mallet, the distal aspects of the bones were resected.* The areas were rasped smooth and flushed with sterile saline solution.
 
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