Query: Digital Amputation
What is the appropriate way to code for a hallux
amputation, metatarsal head resection, and
tibial/fibular sesamoidectomies?
Tejas R. Pandya, DPM
Troy, NY
Codingline Response: The question speaks of a
digital amputation...with resection of the head
of the 1st metatarsal and sesamoids. I believe
the proper coding (assuming this is a left foot)
would be CPT 28122-LT (partial ostectomy,
metatarsal [e.g., osteomyelitis])
CPT 28820-TA-59 (amputation, toe, MTPJ)
Excision of sesamoids would be included in CPT
28122 allowance. CPT 28315 is designated
as "separate procedure" which means it is only
considered for independent reimbursement when it
is unrelated or distinct from other procedures
being performed; CPT 28315 should not be
reported separately.
There are some that feel that the procedures
should be reported as CPT 28810 (amputation,
metatarsal, with toe, single), but I would argue
that, in fact, the procedure described is not
an "amputation, metatarsal, with toe, single",
but an amputation of a toe (left hallux)...with
partial excision metatarsal bone for
osteomyelitis. There is the correctness and
consistency throughout CPT regarding the
definition of 'partial' vs. 'whole.' What is
being done in this case is less than whole --
and that makes it partial [even if 95% of the
metatarsal was removed]. There is no
defined 'amount of metatarsal' (except all of
it) to qualify a partial ostectomy.
I read CPT 28810 as defining an entire ray
amputation - something not performed here. If my
points on the accuracy of the coding doesn't
change your mind, consider that (at least for
2003) CPT 28122 is valued at 17.93 while CPT
28820 is valued at 12.18 RVUs while CPT 28810,
by itself as a suggested billing alternative, is
only valued at a pitiful 14.87 RVUs. I believe
the best code (correct-wise and financially)
would be CPT 28122 and CPT 28820-59.
Harry Goldsmith, DPM
Cerritos, CA
