Wiki Digital amputation with metatarsal head resection. CPT 28820 vs 28810

[miedemarebecca@gmail.com]

I am new to podiatry coding, the situation of a digital amputation of the toes with a portion of the metatarsal head being resected has come up quite often. I am not finding instructions in the CPT code book or hips and below that are definitive for how to proceed in coding this. If I code the 28820 I am completely leaving out the resection of the metatarsal bone. If I code 28810 this includes the entire metatarsal not just the head. Below is an example.

toes were examined and he had some viability at the very base of the toes at the sulcus area therefore it was elected instead of doing a transmetatarsal amputation to perform digital amputations 1-5 which are disarticulations. It should also be noted that the second third and fifth metatarsal heads were resected to make a more even parabola so that there would not be any tension on the wound during closure.

 

[thomas7331]

Podiatry isn't my specialty so someone else may need to correct me here. But if I'm not mistaken, a toe amputation including the metatarsal head is known as a 'ray amputation', which would be coded with 28810. Here's an AAPC article for reference:

https://www.aapc.com/blog/22551-open-mouth-insert-foot-partial-foot-and-toe-amputations/

 

[podcoder70]

Since the bone of the metatarsal was healthy and only resected to enhance the amputation, 28820 would be the most appropriate. If there was osteo in the portion of the metatarsal that was resected, you could also bill 28122. If the toe AND metatarsal or portion of the metatarsal were amputated, then you would code 28810.