# Revision Lower extremity below the knee amputaion



## jfkscindy

Hi,

I have never done amputations so here it goes, the pt all ready had the BTKA...(below-the-knee-amputation) So the pt is back to OR for Revision, the reports states;

The incision was carried across the anterior pat of the leg, incision going longituinally on the medial and lateral aspect of the leg was carried approximately 12 cm to this, going distally on the leg.  These medial and posterior incisions were connected posteriorly across the leg thus creating a posterior flap.  We then took our attention to the anterior more proximal horizontalk incision area and dissection was bluntly taken down using sharp debridement and blunt dissection.  the incision was taken down to the bone.  The posterior tibia neurovascular bundle was encountered, it was tied off using sutures...
We then continued to dissect around the tibial bone.  We continued to go down the lateral aspect of the tibia until the anterior tibia and peroneal neurovascular bundles were both identified.  Both of them were tied off using sutre.  At this point, using a standard hand saw to cut bone, we then cut the tibial bone transversely this cutting the tibial bone in half.  We then going proximal on the tibaia on teh anterior aspect we scribed a wedge onto the anterior aspect of the tibial bone at a 45 degree angle, and this removed the anterior portion fo the distal tibvbial bone to creat a smooth nonprotruding coroner.

Once this was done, attentino was taken to the fibula bone.  using a large bone forceps and going approx 3 cm proximal of the distal end of the tibia, the fibular bone was cut.  We then placed our attention the the distal flap which was then created which included both soft tissue and tibia and fibula.  then using an amputation knife, we continued to remove the distal flap which included tibia, fibula and soft tissue. Onnce that was removed a posterior flap was note to be created.  At this time, all deep posteriror muscle groups were removed andsome areas of mildly compromised devitalized tissue was noted and removed.  We then continued to irrigat the wound...

I have no experience in this area, but I am leaning toward the 27486, 27442 27440 area?? HELP!! Thank you

Cindy K, CPC


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## khopstein

Look at 27886


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## tlipscomb

*Re-amputation*

Can someone please advise whether to code the following as CPT-27886, or 27880? (Reamputation of leg through tibia and fibula.)

I coded it as 27886.


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## tlipscomb

*Re-amputation*

Should Lapidus type bunion correction with sesamoidectomy be coded as 28315 or 28297? I coded it as 288315.


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## tlipscomb

*Lapidus with sesamoidectomy*

Should Lapidus type bunion correction with sesamoidectomy be coded as 28315 or 28297? I coded it as 288315.


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