# Revision of transmetatarsal amputation



## donnagullikson (Dec 14, 2009)

Patient has a revascularized left leg with an open transmetatarsal amputation site.  Procedure performed was further debridement and then final closure.

What CPT would you use?

Thanks,
Donna Gullikson


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## mbort (Dec 14, 2009)

if it was just soft tissue that was debrided look at 11040-11043.  If additional bone was resected and depending on the documentation, you may need use the amputation code 28805 vs 11044.


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## divernan (Dec 30, 2009)

Donna
I have a patient where we just did a revision of a transmetatarsal amputation one month after the first one which was by a doctor who is not in my practice. My doctor did do further amputation of the remaining metatarsals and we billed 28805. Medicare has denied this as "paid only once in a lifetime per beneficiary". So now I am thinking I will resubmit as unlisted code. The documentation is very good and seems more involved than 11044 x 4. However I am still debating which way to go and am interested in what you decided in your case.
Nancy


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## mbort (Dec 31, 2009)

divernan said:


> Donna
> I have a patient where we just did a revision of a transmetatarsal amputation one month after the first one which was by a doctor who is not in my practice. My doctor did do further amputation of the remaining metatarsals and we billed 28805. Medicare has denied this as "paid only once in a lifetime per beneficiary". So now I am thinking I will resubmit as unlisted code. The documentation is very good and seems more involved than 11044 x 4. However I am still debating which way to go and am interested in what you decided in your case.
> Nancy



that seems kinda odd since the patient has two metatarsals.  I don't see any LCD's or MCD's for this code however I did notice that on the MUE there is a 2
keep in mind that MUE can be appealed with documentation as well.


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## divernan (Dec 31, 2009)

I have to admit that I do not fully understand the MUE's and am not clear on what the "2" stands for although I did see that when I looked at the MUE's list. I did read on the FAQ that they could be appealed and was thinking of going that route. But then I may be trying to overthink this whole surgery. However, if a transmetatarsal amputation means an amputation of the midportion of the metatarsals (per the Manual of Ortho Terminology) then if we are removing the remaining portion of the metatarsal after it has been amputated at the midportion . . . then would it really be possible to use the same code again as the MUE seems to say you cannot. Make sense? So I guess that is why I am leaning towards an unlisted code. 

thanks for your response - I obviously am still going back and forth on this one and appreciate any advice/assistance with coding this one correctly. I can also be contacted at nwilliams@sportmed.com
Nancy


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