Podiatry Coding & Billing Alert

Question: If my physician performed a procedure that included an I&D of plantar space infection and partial first ray resection, would the amputation of the toe and metatarsal head be included? The incision was carried to encompass the partial ray resection and the I&D. Is it billable separately (CPT® 28810)? My thought is to use code 28003 for the incision and drainage.

North Carolina Subscriber

Answer: For a partial first ray amputation (hallux and part of the 1st metatarsal), you should use both 28820 (Amputation, toe; metatarsophalangeal joint) and 28122 (Partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; tarsal or metatarsal bone, except talus or calcaneus) with modifier 59 (Distinct procedural service) on 28122.

Code 28003 is appropriate for an I&D that is done below the level of fascia in multiple areas. The description of 28810 reads, “amputation, metatarsal, with toe, single.” If you did not amputate the entire metatarsal, you would not report 28110 (Ostectomy, partial excision, fifth metatarsal head [bunionette] [separate procedure]).

If the I&D was its own distinct procedure or independent from the amputation, then it can be separately billed. In this situation, your documentation should indicate that the I&D was a different procedure or surgery, different site, or a separate incision from the amputation.

So now the question is whether you should code both the I&D and the partial first ray resection. Conversely, the incision portion of your I&D was actually part of the incision to do the partial first ray amputation; my opinion is that the I&D was a component of the amputation and should not be separately billed.