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Excision of sixth toe

  1. #1
    Default Excision of sixth toe
    Exam Training Packages
    Need help finding procedure code, please op note

    PREOPERATIVE DIAGNOSIS: Supra numeric digit left foot.

    POSTOPERATIVE DIAGNOSIS: Supra-numeric digit left foot.

    PROCEDURE: Excision of sixth toe left foot.

    ANESTHESIA: General

    DESCRIPTION OF PROCEDURE: After administration of preoperative antibiotics and satisfactory anesthesia, the left lower extremity was prepped and draped in the usual sterile fashion to the level of the tourniquet about the upper thigh. The limb was exsanguinated and tourniquet applied to 150 mm of Mercury. Total tourniquet time was under 10 minutes.

    The base of the sixth toe was outlined with a marking pen. The planned incision was infiltrated with approximately 5cc of .25 Marcaine plain. An elliptical incision at the base of the toe was carried down sharply through the skin and this toe was amputated without difficulty. The wound was irrigated. The skin was closed with 3.0 Chromic plain gut. A soft tissue dressing was applied. The patient was stable at the completion of the procedure. Estimated blood loss: none. Complications: none.

    Thanks

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    28820 he just amputated the extra digit. In this particular case you will not be able to utilize a T modifier so you will use just LT.

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default 28820 vs 28344
    This is not my area of expertise, but ..

    Wouldn't you use 28344? Here's the lay description
    This is a congenital anomaly where an extra toe is present. Correction is obtained by surgical removal of the accessory digit. An oval shaped incision is made at the base of the toe to be removed. The underlying tendons are drawn distally and divided. The joint capsule of the metatarsophalangeal joint is incised and the joint is disarticulated and the toe is removed. If x-rays reveal any development of an extra metatarsal bone, the incision is continued proximally and the bone is also removed. The incision is closed and a soft dressing is applied.

    I don't see mention of the joint or bone in the procedure. So would you use a -52 modifier?

    In the hand section for polydactyl fingers (CPT 26587) you are directed to use 11200 if there is no bone involvement. But this sure seems like more than just snipping off a skin tag!

    F Tessa Bartels, CPC, CPC-E/M

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default You are right..nice catch
    Quote Originally Posted by FTessaBartels View Post
    This is not my area of expertise, but ..

    Wouldn't you use 28344? Here's the lay description
    This is a congenital anomaly where an extra toe is present. Correction is obtained by surgical removal of the accessory digit. An oval shaped incision is made at the base of the toe to be removed. The underlying tendons are drawn distally and divided. The joint capsule of the metatarsophalangeal joint is incised and the joint is disarticulated and the toe is removed. If x-rays reveal any development of an extra metatarsal bone, the incision is continued proximally and the bone is also removed. The incision is closed and a soft dressing is applied.

    I don't see mention of the joint or bone in the procedure. So would you use a -52 modifier?

    In the hand section for polydactyl fingers (CPT 26587) you are directed to use 11200 if there is no bone involvement. But this sure seems like more than just snipping off a skin tag!

    F Tessa Bartels, CPC, CPC-E/M

    I think you are absolutely right. I never thought about this as being a reconstruction and totally overlooked that possiblity.

  5. #5
    Default sxith toe
    thanks, I was also thinking 28344-52

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