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First Ray Amputation

  1. Talking First Ray Amputation
    Medical Coding Books
    I new to the ASC and I have a question on the CPT codes that would be used for this procedure.

    Right foot first metatarsal osteomyelitis.

    Right foot first metatarsal osteomyelitis.

    Right foot first ray amputation with sesamoid resection.

    MAC plus local consisting of 5 mL of 0.25% Marcaine without epinephrine mixed
    with 5 mL of 2% lidocaine without epinephrine.


    Distal right first metatarsal with sesamoid bone.

    After identification of the patient by name and identification tag in the
    preoperative holding area, the right foot was marked as the correct operative
    site. The patient was brought to the operating room and placed on the
    operating table in the supine position. Intravenous sedation was provided by
    the anesthesia service. A right foot first ray block was performed with the
    above-mentioned anesthetic. The right foot was prepped and draped in the
    standard surgical fashion. No tourniquet was utilized.

    The surgery was begun by completely excising the open sinus tract at the end
    of the right foot at the previous right big toe amputation site. The surgical
    incision was then extended proximally over the medial aspect of the first
    metatarsal. This was subperiosteally exposed and utilizing an oscillating
    saw, the distal first metatarsal shaft was resected. The soft tissue was then
    sharply debrided with a #15 blade scalpel and the sesamoid bones were also
    sharply resected as well.

    Hemostasis was obtained with Bovie cautery and the wound was copiously
    irrigated with normal saline. Closure was obtained utilizing PDS suture and
    nylon suture. A soft bulky dressing was applied to the right foot and the
    patient was transferred to the hospital stretcher and taken to the recovery
    room in stable condition.

    Thanks for the help!!

  2. Default
    CPT 28810 (amputation metatarsal and toe) describes a ray amputation.

    If the note supports that they are cutting through the metatarals that supports the 28810. In your foot you have the tarsals, then metatarsals then phalanges that have the IP, PIP and DIP joints which means that you can amputate the phalanges at any of those three joints or all of them which supports the 28825 code (interphalangeal joints of foot - the hinge synovial joints between the phalanges of the toes. stedmans). Code 28820 would support the removal of the full phalange at where it connects to the metatarsal. (metatarsophalangeal joints - the condylar or ellipsoid synovial joints between the heads of the metatarsals and the bases of the proximal phalanges of the toes. stedman's)

  3. Default regardong the amputation of the toe
    so if the doctor dictates that he amputated up to the proximal metatarsal joint which code would this be the 28820 ? Thank you for your help...

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