# Excision of tip of toe (only bone)



## kibbit99 (Jun 11, 2009)

Physician performed partial amputation, tip of big toe on the right and 
bunionectomy proximal phalangeal osteotomy big toe on right as well.  11752 would not be the procedure because the nail wasn't touched.  Physician advised me only bone was removed.    Thanks in advance!

Kim, CPC


DX:  Hallux valgus, right foot with chronic infection, tip of the distal phalanx, right foot

29898 would cover the bunionectomy, but how would I code the partial amputation?

---this is the amputation part of the procedure only----


PROCEDURE:  We first excised the gangrenous tip of the big toe trying to avoid the nail bed.  It was an elliptical incision and it did remove all the chronically infected (gangrenous) tissues down to the bone.  In order to obtain closure, a good part of the distal phalanx was removed using sharp osteotome and a rongeur.  This was contoured as best as we could to allow closure of the wound.   The dog ears were adjusted on either side.  The closure was then performed using simple nylon sutures, starting in the middle and then working side to side until we had closed the tip of the distal phalanx.


----------



## LTibbetts (Jun 12, 2009)

Look at 28290. I first went to the 281XX series for excision and and then saw the note under 28108.


----------



## kibbit99 (Jun 12, 2009)

*Any other ideas?*

The physician peformed a bunionectomy by performing a proximal phalangeal osteotomy as the second procedure, which would be 28298.  Those two codes would bundle.  I'm thinking there would be no code for the excision since it would bundle in with the bunionectomy, but I am not sure.


Any other ideas anyone?

Thanks,

Kim, CPC


----------



## mitchellde (Jun 12, 2009)

In the note it says "In order to obtain closure, a good part of the distal phalanx was removed using sharp osteotome and a rongeur."   Therefore this was done not therapeutically but in order to obtain clousure for the primary procedure, therefore I say incidental and do not code.

Debra Mitchell, MSPH, CPC-H


----------

