# Metatarsal #5 resection



## madrake

I would like some help coding this.  The Dr's report reads:
We began by taking off the #5 toe. We grasped the toe with a towel clip and resected with a 15-blade at the MP joint level. When this was completed we resected with sagittal saw the #5 metatarsal bone proximally.
I'm not sure what code to use for the resection of the metatarsal resection.  I'm thinking 28122, but the assistan surgeon's office is stating 28308.
Any ideas?


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## Bella Cullen

I used to work for a Podiatrist and I would code that as 28122. I agree with you.


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## mbort

Was this done in addition to an amputation?  "We began by taking off the #5 toe".??


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## madrake

mbort said:


> Was this done in addition to an amputation?  "We began by taking off the #5 toe".??



Yes it was.  Would that change the code?


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## mbort

madrake said:


> Yes it was.  Would that change the code?



I believe so.  I'm thinking that this may be just 28810 which is the resection of the metatarsal w.toe.

what code are you using for the amputation portion?

Mary,CPC, COSC


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## madrake

mbort said:


> I believe so.  I'm thinking that this may be just 28810 which is the resection of the metatarsal w.toe.
> 
> what code are you using for the amputation portion?
> 
> Mary,CPC, COSC



I would think that code 28810 would be a complete amputation of the metatarsal and not just a resection? I used code 28820 for the toe amputation, because it was at the metatarsophalangeal joint.  My thinking is that code does not include any removal of the metatarsal.  This seems to me like it should be easy to code, but I always question if I'm doing it correct.


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## madrake

madrake said:


> I would think that code 28810 would be a complete amputation of the metatarsal and not just a resection? I used code 28820 for the toe amputation, because it was at the metatarsophalangeal joint.  My thinking is that code does not include any removal of the metatarsal.  This seems to me like it should be easy to code, but I always question if I'm doing it correct.



What about code 28813?


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## mbort

it gets really confusing I know. I dont see 28813???

The 28122 bundles with 28820 though, so you will only be able to capture the 28820.


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## madrake

mbort said:


> it gets really confusing I know. I dont see 28813???
> 
> The 28122 bundles with 28820 though, so you will only be able to capture the 28820.



Sorry, 28113 not 28813.


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## madrake

madrake said:


> Sorry, 28113 not 28813.



I think if the Dr amputates the toe at the metatarsophalangel joint I will code 28820 and not the resection of the metatarsal (since it seems to be bundled).
If he just does a metatarsal resection with out the amputation, I'm going to use code code 28111-28114.  
Let me know if you agree.  I really appreciate all of your help!


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## mbort

sounds good   you're welcome


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## Bella Cullen

In that case, if he took off the metatarsal and toe then I would code that as 28810 ONLY, because that is for amputation of a metatarsal bone and its attached toe. 
28820 is just for an amputation at the metatarsalphalangeal joint level. 

I would not use 28113 because that is for excision of the metatarsal head only.


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## Bella Cullen

If in the op note it says anything like incision deep to the metatarsalphalangeal joint, and the proximal phalanx bone was disarticulated from the metatarsal bone, but nothing about the metatarsal being disarticulated then this would be 28820. 

Complete removal of just the metatarsal bone would be 28140. Partial excision of just the metatarsal bone would be 28122.
And then what I just wrote previously. 

Hope that helps. 
Daisy


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## madrake

DaisyAnn said:


> If in the op note it says anything like incision deep to the metatarsalphalangeal joint, and the proximal phalanx bone was disarticulated from the metatarsal bone, but nothing about the metatarsal being disarticulated then this would be 28820.
> 
> Complete removal of just the metatarsal bone would be 28140. Partial excision of just the metatarsal bone would be 28122.
> And then what I just wrote previously.
> 
> Hope that helps.
> Daisy



He removed the toe at the metatarsophalangeal joint, but also did a metatarsal resection.  He didn't remove all of the metatarsal. 
So, if he removes the toe at the metatarsophalangeal joint and does a metatarsal resection code 28820 and 28122? If her removes all of the metatarsal and toe I will code 28810.


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## amitjoshi4

Hi,

I would rather use two CPT's to describe this procedure. No single CPT covers this entire procedure.

28122 and 28150 are two CPT  to be used here.

Please make me correct if you find something else.

Thank You


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## Bella Cullen

madrake said:


> He removed the toe at the metatarsophalangeal joint, but also did a metatarsal resection.  He didn't remove all of the metatarsal.
> So, if he removes the toe at the metatarsophalangeal joint and does a metatarsal resection code 28820 and 28122? If her removes all of the metatarsal and toe I will code 28810.



Yes, I would definetly code this as 28820, 28122-59. 
And yes, if he removes all of the metatarsal and toe it would be 28810.


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## madrake

DaisyAnn said:


> Yes, I would definetly code this as 28820, 28122-59.
> And yes, if he removes all of the metatarsal and toe it would be 28810.



Thank you, I agree.


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## mbort

how will you justify the use of the modifier 59?


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## oahfarm

*Study Books for Orthopedic Speciality exams*

Can anyone tell what books there to help me prepare for COSC?  I am planning on doing the Practicum online as well as.  Thanks.


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## Bella Cullen

mbort said:


> how will you justify the use of the modifier 59?



per cci edits that code needs a 59 modifier. 
And they are two separate procedures. 28820 is for amp at metatarsalphalangeal level and 28122 is for partial resection of the metatarsal bone itself.


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## mbort

I understand CCI edits require the 59, but I do not see anything that justifies the use of it.  There is nothing separate and distinct to me to justify the use of the 59 modifier. The metatarsal head was resected as incident to the amputation, thats why the CCI edits bundled it.

Mary, CPC, COSC


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## mbort

ok so this has been really bugging me all day so I had to do some further research.

Per the AAOS 2009 Complete Global Service Data

The CPT code 28220 includes the following procedures as part of the global surgical package:
28232
28234
28270
28288
and *28122* 

This confirms my thought process that the 59 modifier would not be justified unless it was on a different metatarsal.

Mary, CPC, COSC


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## Bella Cullen

mbort said:


> ok so this has been really bugging me all day so I had to do some further research.
> 
> Per the AAOS 2009 Complete Global Service Data
> 
> The CPT code 28220 includes the following procedures as part of the global surgical package:
> 28232
> 28234
> 28270
> 28288
> and *28122*
> 
> This confirms my thought process that the 59 modifier would not be justified unless it was on a different metatarsal.
> 
> Mary, CPC, COSC



It's 28820 and 28122 not 28220.
According to the coders desk reference 28820 is an amputation of a toe at the level of the metatarsopalangeal joint, the proximal phalanx is disarticulated  from the metatarsal bone. They don't go into the metatarsal at all in this code. So then you would code 28122 for the partial excision of a metatarsal bone.


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## mbort

sorry for the typo, that is the AAOS global service package for 28820.

We will have to agree to disagree on this one. I understand the CDR, however I also utilize the AAOS as a premium guide when coding Ortho cases.

In my opinion, there is nothing distinct to stand alone to justify the use of the -59 modifier.

Mary, CPC, COSC


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## Bella Cullen

Ok, I think the AAOS is a good reference to go by, and they are probably saying it is inclusive because you go so close to the metatarsal bone that they are just including that. So I see your point as to why you go by them, but I'm going by what the CDR says and also I have Netters Atlas of Human Anatomy for CPT coding and I use that to look at the bones of the foot. So I guess we will agree to disagree on this one.


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