Podiatry Coding & Billing Alert

Report 28825 if the podiatrist amputates the patient’s toe at the interphalangeal joint.

When you code for amputations, you must know whether the podiatrist amputated a toe or foot, which part of the toe or foot he amputated, and whether the amputation was partial or complete. Understanding all of the nuances of amputation coding can be challenging, but you don’t have to fall behind.

Answer the following questions to always submit clean amputation claims in your podiatry practice.

Podiatrist Performed Midtarsal Amputation? Report 28800

Question 1: The podiatrist documented that he performed a Chopart type procedure — an amputation of the patient’s left foot at the midtarsal. What CPT^® code should I report for this procedure?

Answer 1: You should report 28800 (Amputation, foot; midtarsal (eg, Chopart type procedure)) for this service. When a podiatrist performs a 28800 service, he amputates the foot just in front of the heel and ankle. This amputation is at the midtarsal joints through the talonavicular and calcaneocuboid joints.

Midtarsal joints defined: Midtarsal joints are also known as transverse tarsal joints. They are combined joints of either the talus with the navicular bone or the calcaneum with the cuboid bone.

Don’t Confuse Toe and Foot Amputations

Question 2: Can you explain the difference between codes 28805 and 28810?

Answer 2: If the surgeon performs a transmetatarsal foot amputation, then you would report 28805 (Amputation, foot; transmetatarsal), In this procedure, the provider amputates the foot by cutting it across the metatarsal bones.

On the other hand, you would report 28810 (Amputation, metatarsal, with toe, single) when the surgeon amputates a single metatarsal bone along with its attached toe.

Check Out This 28820 Example

Question 3: I’m new to podiatry, and I was wondering if you could give me an example of how to correctly report 28820?

Answer 3: After having an accident with a lawnmower, an established patient goes to the podiatrist’s office thinking he only has a laceration on his right great toe. After evaluation, the podiatrist schedules a toe amputation to be performed the following day. The next day, he amputates the toe at the metatarsophalangeal joint.

You should report 28820 and 99213-57 for this scenario.

You should report 28820 (Amputation, toe; metatarsophalangeal joint) for the toe amputation. You can also report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity) because the podiatrist didn’t plan the amputation prior to the evaluation.

Don’t forget: Use modifier 57 (Decision for surgery) when the evaluation and management (E/M) service directly led to the podiatrist’s decision to perform surgery. Always append modifier 57 to the E/M service code. If you append modifier 57 to procedure codes, you can expect claims denials.

Report 28825 in This Case

Question 4: If the podiatrist amputates the patient’s second toe at the interphalangeal joint on his right foot, which procedure code should I report?

Answer 4: If the podiatrist amputates the patient’s toe at the interphalangeal joint, the joint between two bones, you should report 28825 (Amputation, toe; interphalangeal joint). You should also append modifier T6 (Right foot, second digit) to 28825 indicate that this was the second toe on the right foot.

Discover Dx Code for Great Toe Complete Traumatic Amputation

Question 5: The podiatrist documented a complete traumatic amputation of the patient’s right great toe. Which ICD-10 code should we look to for this diagnosis? This was an initial encounter.

Answer 5: You should report S98.111A (Complete traumatic amputation of right great toe, initial encounter) for this diagnosis.

Note you would report a different set of codes if the podiatrist performs a partial amputation. For example, if the podiatrist had performed a partial traumatic amputation of the patient’s right great toe, then you would report S98.121A (Partial traumatic amputation of right great toe, initial encounter).

Identify Dx Code for Partial Traumatic Amputation of Lesser Toes

Question 6: The podiatrist performed a partial traumatic amputation of two of the patient’s right lesser toes. This was an initial encounter. What ICD-10 code should we report for this diagnosis?

Answer 6: You should report S98.221A (Partial traumatic amputation of two or more right lesser toes, initial encounter) for this diagnosis. However, if the podiatrist performed a complete amputation instead, you would report 298.211A (Complete traumatic amputation of two or more right lesser toes).