Wiki Metatarsal #5 resection

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madrake

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I would like some help coding this. The Dr's report reads:
We began by taking off the #5 toe. We grasped the toe with a towel clip and resected with a 15-blade at the MP joint level. When this was completed we resected with sagittal saw the #5 metatarsal bone proximally.
I'm not sure what code to use for the resection of the metatarsal resection. I'm thinking 28122, but the assistan surgeon's office is stating 28308.
Any ideas?
 
mbort said:
I believe so. I'm thinking that this may be just 28810 which is the resection of the metatarsal w.toe.

what code are you using for the amputation portion?

Mary,CPC, COSC
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I would think that code 28810 would be a complete amputation of the metatarsal and not just a resection? I used code 28820 for the toe amputation, because it was at the metatarsophalangeal joint. My thinking is that code does not include any removal of the metatarsal. This seems to me like it should be easy to code, but I always question if I'm doing it correct.
 
madrake said:
I would think that code 28810 would be a complete amputation of the metatarsal and not just a resection? I used code 28820 for the toe amputation, because it was at the metatarsophalangeal joint. My thinking is that code does not include any removal of the metatarsal. This seems to me like it should be easy to code, but I always question if I'm doing it correct.
Click to expand...

What about code 28813?
 
it gets really confusing I know. I dont see 28813???

The 28122 bundles with 28820 though, so you will only be able to capture the 28820.
 
madrake said:
Sorry, 28113 not 28813.
Click to expand...

I think if the Dr amputates the toe at the metatarsophalangel joint I will code 28820 and not the resection of the metatarsal (since it seems to be bundled).
If he just does a metatarsal resection with out the amputation, I'm going to use code code 28111-28114.
Let me know if you agree. I really appreciate all of your help!
 
In that case, if he took off the metatarsal and toe then I would code that as 28810 ONLY, because that is for amputation of a metatarsal bone and its attached toe.
28820 is just for an amputation at the metatarsalphalangeal joint level.

I would not use 28113 because that is for excision of the metatarsal head only. :)
 
If in the op note it says anything like incision deep to the metatarsalphalangeal joint, and the proximal phalanx bone was disarticulated from the metatarsal bone, but nothing about the metatarsal being disarticulated then this would be 28820.

Complete removal of just the metatarsal bone would be 28140. Partial excision of just the metatarsal bone would be 28122.
And then what I just wrote previously.

Hope that helps.
Daisy ;)
 
DaisyAnn said:
If in the op note it says anything like incision deep to the metatarsalphalangeal joint, and the proximal phalanx bone was disarticulated from the metatarsal bone, but nothing about the metatarsal being disarticulated then this would be 28820.

Complete removal of just the metatarsal bone would be 28140. Partial excision of just the metatarsal bone would be 28122.
And then what I just wrote previously.

Hope that helps.
Daisy ;)
Click to expand...

He removed the toe at the metatarsophalangeal joint, but also did a metatarsal resection. He didn't remove all of the metatarsal.
So, if he removes the toe at the metatarsophalangeal joint and does a metatarsal resection code 28820 and 28122? If her removes all of the metatarsal and toe I will code 28810.
 
Hi,

I would rather use two CPT's to describe this procedure. No single CPT covers this entire procedure.

28122 and 28150 are two CPT to be used here.

Please make me correct if you find something else.

Thank You
 
madrake said:
He removed the toe at the metatarsophalangeal joint, but also did a metatarsal resection. He didn't remove all of the metatarsal.
So, if he removes the toe at the metatarsophalangeal joint and does a metatarsal resection code 28820 and 28122? If her removes all of the metatarsal and toe I will code 28810.
Click to expand...

Yes, I would definetly code this as 28820, 28122-59.
And yes, if he removes all of the metatarsal and toe it would be 28810.
 
Study Books for Orthopedic Speciality exams

Can anyone tell what books there to help me prepare for COSC? I am planning on doing the Practicum online as well as. Thanks.
 
mbort said:
how will you justify the use of the modifier 59?
Click to expand...

per cci edits that code needs a 59 modifier.
And they are two separate procedures. 28820 is for amp at metatarsalphalangeal level and 28122 is for partial resection of the metatarsal bone itself. :)
 
I understand CCI edits require the 59, but I do not see anything that justifies the use of it. There is nothing separate and distinct to me to justify the use of the 59 modifier. The metatarsal head was resected as incident to the amputation, thats why the CCI edits bundled it.

Mary, CPC, COSC
 
ok so this has been really bugging me all day so I had to do some further research.

Per the AAOS 2009 Complete Global Service Data

The CPT code 28220 includes the following procedures as part of the global surgical package:
28232
28234
28270
28288
and 28122

This confirms my thought process that the 59 modifier would not be justified unless it was on a different metatarsal.

Mary, CPC, COSC
 
mbort said:
ok so this has been really bugging me all day so I had to do some further research.

Per the AAOS 2009 Complete Global Service Data

The CPT code 28220 includes the following procedures as part of the global surgical package:
28232
28234
28270
28288
and 28122

This confirms my thought process that the 59 modifier would not be justified unless it was on a different metatarsal.

Mary, CPC, COSC
Click to expand...

It's 28820 and 28122 not 28220.
According to the coders desk reference 28820 is an amputation of a toe at the level of the metatarsopalangeal joint, the proximal phalanx is disarticulated from the metatarsal bone. They don't go into the metatarsal at all in this code. So then you would code 28122 for the partial excision of a metatarsal bone.
 
sorry for the typo, that is the AAOS global service package for 28820.

We will have to agree to disagree on this one. I understand the CDR, however I also utilize the AAOS as a premium guide when coding Ortho cases.

In my opinion, there is nothing distinct to stand alone to justify the use of the -59 modifier.

Mary, CPC, COSC
 
Ok, I think the AAOS is a good reference to go by, and they are probably saying it is inclusive because you go so close to the metatarsal bone that they are just including that. So I see your point as to why you go by them, but I'm going by what the CDR says and also I have Netters Atlas of Human Anatomy for CPT coding and I use that to look at the bones of the foot. So I guess we will agree to disagree on this one. :)
 
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