# Foot Amputation then BKA



## ksb0211 (Jan 18, 2012)

Hi, all!  I do the coding for general surgeons and amputations are not all that common.  I'm just hoping for some opinions of those with a bit more experience here.  The patient was taken to the OR for amputation, foot on 12/12/2011.  Then on 12/16/2011, was taken back for BKA (this was staged).  I just don't want to incorrectly code this one out.  Thanks for any input.  Both op reports to follow:

DATE OF PROCEDURE
12/12/2011

PRE/POSTOPERATIVE DIAGNOSIS
Gangrenous change, right foot.
OPERATION PERFORMED
Guillotine amputation, right foot.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR after induction of adequate general anesthesia.  The patient was prepped with Betadine and draped sterilely.  The patient has had evidence of sepsis, recent myocardial infarction and a gangrenous change of the right foot.  Guillotine amputation is planned to remove the source of sepsis, as well as allows further stabilization of the patient.  The foot had been draped and isolated from the wound.  The incision was made 3 fingerbreadths above the malleolus.  The incision was made with a #10 blade, carried down to subcutaneous tissues.  The venous structures were ligated as were the arterial structures utilizing 3-0 silk suture.  The bone was then divided with a Stryker saw.  The periosteal elevator was utilized and the mobilization of the soft tissue was performed.  The Stryker saw was utilized again to bring the bone up to above the skin level.  The skin was then able to be reapproximated temporarily utilizing 2-0 nylon vertical mattress sutures.  Hemostasis had been achieved.  A dry sterile dressing was applied.  The patient tolerated the procedure.

DATE OF SURGERY
12/16/2011
PRE/POSTOPERATIVE DIAGNOSIS
Nonviable right lower extremity.
OPERATION PERFORMED
Right below-knee amputation.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room after attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion.  Prepped out his leg and then marked off the previous guillotine amputation site, then reprepped again.  Once that was done we made our incision.  We marked out the knee, the leg about 4 fingerbreadths down from the tibial prominence and then made an additional 4 fingerbreadths below that to make our posterior flap.  We made our incision, described as flaps as we just laid them out and then we were using primarily Bovie and carried our dissection down, exposed the tibia and then also the fibula.  We took the fibula up a bit higher on that side using a power tool and then took down the tibia as well, we were again using a power tool.  I came from the front of the tibia.  Once that was done, we used an amputation knife to remove the, going through the posterior muscular bundle.   All arterial vessels were noted to be calcific but we were also able to tie this off with 3-0 Vicryls.  We irrigated, then tailored the muscles some, the gastroc was tailored in part to make sure that we had good fit of our flap.  We placed a 10 mm Jackson-Pratt into position and then brought our flap anteriorly covering the bone with surrounding muscle and then making sure our flaps skin edges matched up.  We had to trim the skin some to make sure that we had a nice lie of the skin itself.  Once that was done, we closed with skin staples.  He tolerated the procedure well.


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## purplescarf23 (Jan 24, 2012)

12/12/11 I would code 27882-Amputation, leg, through tibia and fibula; open, circular (guillotine) and for 12/16/11 I would code 27880-Amputation, leg, through tibia and fibula.  

You stated the 12/16/11 was staged so I am assuming the provider made notation that they would need to further amputate the leg?  Or was this unplanned at the time of the first surgery?  

Kelsey, CPC


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