# First Ray Amputation



## oakgirl75

I new to the ASC and I have a question on the CPT codes that would be used for this procedure.

PREOPERATIVE DIAGNOSIS
Right foot first metatarsal osteomyelitis.

POSTOPERATIVE DIAGNOSIS
Right foot first metatarsal osteomyelitis.

OPERATION PERFORMED
Right foot first ray amputation with sesamoid resection.

ANESTHESIA
MAC plus local consisting of 5 mL of 0.25% Marcaine without epinephrine mixed  
with 5 mL of 2% lidocaine without epinephrine.

COMPLICATIONS
None.

SPECIMEN(S)
Distal right first metatarsal with sesamoid bone.

DESCRIPTION OF PROCEDURE IN DETAIL
After identification of the patient by name and identification tag in the  
preoperative holding area, the right foot was marked as the correct operative  
site.  The patient was brought to the operating room and placed on the  
operating table in the supine position.  Intravenous sedation was provided by  
the anesthesia service.  A right foot first ray block was performed with the  
above-mentioned anesthetic.  The right foot was prepped and draped in the  
standard surgical fashion.  No tourniquet was utilized.

The surgery was begun by completely excising the open sinus tract at the end  
of the right foot at the previous right big toe amputation site.  The surgical
 incision was then extended proximally over the medial aspect of the first  
metatarsal.  This was subperiosteally exposed and utilizing an oscillating  
saw, the distal first metatarsal shaft was resected.  The soft tissue was then
 sharply debrided with a #15 blade scalpel and the sesamoid bones were also  
sharply resected as well.  

Hemostasis was obtained with Bovie cautery and the wound was copiously  
irrigated with normal saline.  Closure was obtained utilizing PDS suture and  
nylon suture.  A soft bulky dressing was applied to the right foot and the  
patient was transferred to the hospital stretcher and taken to the recovery  
room in stable condition.

Thanks for the help!!


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## Jeffs1977

CPT 28810 (amputation metatarsal and toe) describes a ray amputation.

If the note supports that they are cutting through the metatarals that supports the 28810. In your foot you have the tarsals, then metatarsals then phalanges that have the IP, PIP and DIP joints which means that you can amputate the phalanges at any of those three joints or all of them which supports the 28825 code (interphalangeal joints of foot - the hinge synovial joints between the phalanges of the toes. stedmans). Code 28820 would support the removal of the full phalange at where it connects to the metatarsal. (metatarsophalangeal joints - the condylar or ellipsoid synovial joints between the heads of the metatarsals and the bases of the proximal phalanges of the toes. stedman's)


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## doranvalerie@yahoo.com

*regardong the amputation of the toe*

so if the doctor dictates that he amputated up to the proximal metatarsal joint which code would this be the 28820 ? Thank you for your help...


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