Wiki Need CPT bundling help!

[meggie]

I am trying to find out if CPT 14350 (filleted finger or toe flap, including preparation of recipient site) can be billed with amputation code 28805? Is one included with the other? How am I able to bill these 2 codes? I appreciate any and all help!!

 

[danskangel313]

Code 28805 Amputation, foot; transmetatarsal, is an amputation in which the surgeon creates a skin flap at the beginning in order to do the amputation and then uses that flap to close the stump.

Code 14350 Filleted finger or toe flap, including preparation of recipient site, is for fingers and toes, not for a foot amputation.

The codes don't bundle because they are completely separate procedures, for separate purposes, on separate sites. I'm not understanding why you'd want to bill them together if you're just doing the foot amputation. Do you have the op note or narrative?

 

[meggie]

the procedure on the op report states, "Amputation at the transmetatarsal level of the great toe with partial toe fillet flap." So, my question is, can they be billed together since they are both for the feet/toe, or is one combined with the other?

 

[danskangel313]

the procedure on the op report states, "Amputation at the transmetatarsal level of the great toe with partial toe fillet flap." So, my question is, can they be billed together since they are both for the feet/toe, or is one combined with the other?

Well, by definition "transmetatarsal" refers to amputation of all toes at the metatarsals, which is 28805. The narrative is a little confusing, because I'm not understanding what the surgeon means by "transmetatarsal level" of the great toe. Is there any more information as to what exactly was amputated?

To try to help answer your question, try to think of it like this in super generic terms:
28805 Amputation, foot; transmetatarsal - you have a zip-lock baggie with candy in it. you open it up, take out the candy, then zip it closed again using the existing zipper. it's KINDA like that. there's really no need for anything else to close it up.
14350 Filleted finger or toe flap, including preparation of recipient site - they literally slice your finger or toe open from top to bottom, like a hot dog bun. then everything is taken out (bones, tissues, etc) and the remaining skin is the "flap".

Why would there be the need to create the flap from a toe (which would have been removed) if the skin to close the stump already existed? Do you know what I mean?

 

[meggie]

yes, that makes so much more sense than anything with this surgery so far!! I appreciate your help! I will review the op report again and double check on the codes he gave me. It didn't make sense from the beginning, so I appreciate you helping me with this!!

 

[meggie]

Here is a couple snippets from the op report:

" The patient was placed on the operating table, given MAC anesthetic. Left foot was prepped and draped. Local anesthetic infusion was performed. I then cut the sidewalls of the open wound on the inner portion of the great toe metatarsal area and the red granulation tissue showed me where to cut out. Next, an incision along the lateral aspect of the great toe and amputated at the proximal distal phalanx of the great toe leaving as much tissue on the opposite side as possible. I dissected pack proximally removing much of the granulation tissue and subperiosteal level elevated up periosteum of the metatarsal back towards the metatarsal level. A sagittal saw was then cut off the head of the metatarsal, which was very rounded and with was sent for pathologic review. "

I'm not sure if that will be helpful at all or if more info will be needed. But does this kind of give an idea of the problem I'm having?

 

[danskangel313]

Here is a couple snippets from the op report:

" The patient was placed on the operating table, given MAC anesthetic. Left foot was prepped and draped. Local anesthetic infusion was performed. I then cut the sidewalls of the open wound on the inner portion of the great toe metatarsal area and the red granulation tissue showed me where to cut out. Next, an incision along the lateral aspect of the great toe and amputated at the proximal distal phalanx of the great toe leaving as much tissue on the opposite side as possible. I dissected pack proximally removing much of the granulation tissue and subperiosteal level elevated up periosteum of the metatarsal back towards the metatarsal level. A sagittal saw was then cut off the head of the metatarsal, which was very rounded and with was sent for pathologic review. "

I'm not sure if that will be helpful at all or if more info will be needed. But does this kind of give an idea of the problem I'm having?

This reads to me like only the great toe was amputated. But I'm a bit confused on exactly where the amputation occurred; the distal phalanx is the bone at the tip of the toe and the proximal phalanx is the bone between the distal and the metatarsal. "Proximal distal phalanx" technically means the amputation was of the distal phalanx at the proximal end, but there'd be no distal end to the distal phalanx because it's the last bone in the toe. Then there's mention of removing the head of the metatarsal, which I'm not sure how that'd be done without removing the proximal phalanx first. There's nothing in the narrative to indicate the proximal phalanx was removed unless that's what the provider meant when he/she stated "Proximal distal phalanx". To me, what seems to make the most sense is if both the proximal AND distal phalanx were completely removed plus the head of the metatarsal.

Regarding "Amputation at the transmetatarsal level of the great toe with partial toe fillet flap.", using the above information, I believe the use of "transmetatarsal level" is actually to explain only a portion of the metatarsal was removed; "transmetatarsal level" meaning "across the metatarsal" versus above or below it.

The last thing is the references to the "wound." Depending on where and what the wound was can possibly change your codes. I've come up with several possibilities for codes, but it'd all depend on things like if both the proximal AND distal phalanx were removed, and what and where the wound was, also what was sent to pathology - tissue or bone? I'm not completely sure if any of the "amputation" codes would appropriate given that a certain amount of tissue was saved and so on.