# Excision of sixth toe



## sxcoder05 (Nov 19, 2008)

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


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## mbort (Nov 19, 2008)

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.


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## FTessaBartels (Nov 21, 2008)

*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


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## mbort (Nov 21, 2008)

*You are right..nice catch*



FTessaBartels said:


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


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## sxcoder05 (Nov 24, 2008)

*sxith toe*

thanks, I was also thinking 28344-52


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