Podiatry Coding & Billing Alert

Question: A patient presented in the emergency department with partial traumatic amputation of his right distal phalanx following a lawn-mower accident, and our podiatrist, who was on call, determined that the end of the toe could not be replanted. The podiatrist then used a bone rongeur instrument to debride and round the bone to close the wound over it. Should I report a debridement code or an amputation code? If I should report an amputation code, what will cover a distal phalanx amputation? 

Virginia Subscriber

Answer: You should not report an amputation code for this procedure. Most of the amputation occurred before the patient arrived at the hospital, and the physician just cleaned up the amputation. This scenario calls for a code for debridement and simple closure instead.

Report the debridement as 11044 (Debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 sq cm or less) because the physician debrided not only the skin but also the muscle and bone.

FYI: In a separate situation, if you needed to report a toe amputation procedure, you would use 11752 (Excision of nail and nail matrix, partial or complete [e.g., ingrown or deformed nail] for permanent removal; with amputation of tuft of distal phalanx).

CPT^® directs you here because the 28800-28825 codes for amputation involve the whole foot or a larger section of the toe. Also note that 11752 bundles the closure, unlike the debridement code.