Cpt code removal of metatarsal stump

Transcription

1 Cpt code removal of metatarsal stump This article will focus on the definitions of three root operations: by The American Health Information Management Association. All Rights Reserved. Osteotomy is a surgical procedure that changes the alignment of a bone with or without removal of a portion of that bone. It may be considered for correction of a malaligned fracture, osteoarthritis or other joint conditions. Many of the above bunionectomy procedures allowed additional billing and reimbursement for several different osteotomy procedures, such as CPT codes 28306, and These procedures are described below. Editor's note: This is the second in a series of 10 articles discussing the 31 root operations of ICD-10-PCS. Foot and toe coding take teamwork and can at times encompass a great deal of surgeon involvement. Set up internal policies related to coding feet procedures by surgeon if you need to. Just as hospitals have "preference cards" alerting the hospital surgical crew as to what a particular surgeon "prefers" or needs for a certain procedure so that policies can be developed and updated to help assist in correct coding of procedures performed by surgeons. Surgeons usually do not learn CPT language and descriptions as part of their medical training so many times their narrative descriptions do not say the same exact wording as CPT, but are indeed referring to the same procedure performed. Have access to medical publications relating to feet procedures. Many surgeons have these books in their libraries that can be referenced for clarification. Understand the anatomy of the foot and the terminology associated with the feet. The definition for the root operation Extraction provided in the ICD-10-PCS Reference Manual is "Pulling or stripping out or off all or a portion of a body part by the use of force." Extraction is coded when the method employed to take out the body part is pulling or stripping, and any minor cutting-such as that used in vein stripping procedures-is included in the Extraction. Barta, Ann. "Coding Root Operations with ICD-10-PCS: Understanding Detachment, Destruction, and Extraction" ; simple exostectomy This procedure is just thata simple exostectomy Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal. Source: Centers for Medicare and Medicaid Services. "ICD-10-PCS Draft Coding Guidelines." ; Keller, McBride or Mayo type procedures These particular procedures involve a distal soft tissue release (McBride), a resection of the base of the proximal phalanx (Keller), or a resection of the metatarsal head (Mayo). AAOS states that this procedure includes: arthrotomy, synovial biopsy, tendon release or transfer, synovectomy, capsular release and reconstruction, removal of additional exostoses in the area of that joint, internal fixation, articular shaving, arthroscopy, removal of bursal tissue, repair of released tendon, capsular arthroplasty, first metatarsal head resection and excision of bone or synovial cysts and allows additional coding and report for: phalangeal osteotomy to correct deformity, proximal first metatarsal osteotomy and ankle tendon lengthening. Each bunionectomy code has the same "root" procedure, which is "Correction, hallux valgus (bunion), with or without sesamoidectomy;" where they differ is the descriptions after the semi-colon. Since each bunionectomy code describes the correction of the bunion, the actual way that the bunion is being corrected is where we will need to focus. Keep in mind that "eg" is just an example and NOT all-inclusive. There are many different names associated with bunionectomy procedures. The important part is linking the type of bunion procedure with the appropriate bunion code listed in the CPT manual. When reporting the above procedures along with a bunion procedure, you will need to make sure that a modifier is appended, such as modifier -59 to indicate that these

2 osteotomy procedures are above and beyond those procedure necessary to perform this coded bunionectomy and are performed at a separate site or through a separate incision. If you are also performing hammertoe repairs on different toes at the same time as a bunion procedure, you will want to make sure that you append the appropriate toe modifiers to indicate that the procedures are taking place on different toes. AAOS states that this procedure includes: arthrotomy, synovial biopsy, extensor tenotomy, synovectomy, capsular release and reconstruction, removal of additional exostoses in the area of that joint, internal fixation, articular shaving, arthroscopy, removal of bursal tissue, excision of redundant skin and closure, capsular arthroplasty, excision of bone or synovial cysts and allows additional coding and report for: phalangeal osteotomy to correct deformity, proximal first metatarsal osteotomy and ankle tendon lengthening. The fifth character of the code identifies the technique used to reach the operative site. The approach for the bone marrow biopsy was percutaneous (3). In ICD-10-PCS the fifth character always identifies the specific approach utilized to reach the operative site ; by phalanx osteotomy This procedure includes a proximal phalanx osteotomy of the great toe. AAOS states that this procedure includes: arthrotomy, synovial biopsy, synovectomy, capsular release and/or reconstruction, removal of additional exostoses in the area of the joint, internal fixation, removal of bursal tissue, local bone graft, excision of bone or synovial cysts, partial excision of metatarsal and allows additional coding and report for: proximal first metatarsal osteotomy, distal first metatarsal osteotomy, ankle tendon lengthening. A bone marrow biopsy procedure was performed. During this procedure an 11-gauge Jamshidi biopsy needle was used to obtain a bone marrow biopsy sample from the right posterior iliac crest. On a daily basis, these questions and many more are asked when coders/billers/ surgeons try to select the correct code for the feet procedures being performed. This article will shed some light on the CPT codes, what they represent and tips in selecting the most appropriate based on documentation supplied ; resection of joint with implant (Keller-Mayo Procedure with implant) This procedure involves resection of all or half of the metatarsophalangeal joint with the insertion of a double or single stemmed implant. AAOS states that this procedure includes: arthrotomy, synovial biopsy, tendon release or transfer, synovectomy, capsular release and reconstruction, removal of additional exostoses in the area of that joint, internal fixation, arthroscopy, removal of bursal tissue, repair of released tendon, excision of bone or synovial cysts, removal of first metatarsophalangeal joint, and all types of implants and implant fixation and allows additional coding and reports for: phalangeal osteotomy to correct deformity, proximal first metatarsal osteotomy and ankle tendon lengthening Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head. A Therma-Choice balloon endometrial ablation procedure was performed. During this procedure the Therma-Choice catheter with balloon was placed inside the endometrial cavity and slowly filled with fluid until it stabilized at a pressure of approximately 175 to 180 mmhg. Eight minutes of therapeutic heat was applied to the lining of the endometrium. Implantation into local muscle has also provided excellent results in most anatomic locations and is probably the most widely used medium in the foot.21 Wolfort and Dellon resected 17 recurrent interdigital neuromas that occurred as a result of standard Morton's neuroma excision. They used a plantar approach and implanted the resected stump into adjacent intrinsic muscles. They had good to excellent results in all patients with a mean follow up of 33.8 months. They implanted the nerve segment without tension into local muscle, using a 6-0 nylon epineurial stitch to secure the nerve to the muscle belly. Question: A patient presented to our office with a possible neuroma of the right lower limb. The patient had an amputation approximately six years ago. The physician injected the patient with 1cc lidocaine, 3mg celestone and 1cc bupivicaine 0.25 percent. The ICD-9 codes used were 729.5, 719.7, and The patient was injected in the right stump. What CPT codes should I use? Happy Halloween! Get 20% off* TCI SuperCoder products.

3 SuperCoder is powered by the experienced coding and compliance professionals at TCI. TCI's vision is to deliver innovative healthcare solutions and knowledge to our customers worldwide. Access to the largest healthcare job database in the world. Krishnan and colleagues have described a more complicated technique of covering these damaged nerves with a pedicled regional flap or free flap.16 They found it to be effective and attractive for complex stump neuromas. Due to its complex nature and extensive recovery, one should consider this technique for the more advanced or failed therapies.16. AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals. Use this code for amputation between proximal and middle phalanges or middle and distal phalanges in toes two through five, or amputation between the distal and proximal phalanges in the big toe. 003: CPT Assistant Dec 10: : CPT Assistant Oct 98: : CPT Assistant Sep 00: 9. In the foot, however, iatrogenic etiologies are more frequent. Researchers have reported that up to 30 percent of stump neuromas elicit pain.1 It is unclear why some are painful and others are not, but it most likely relates to the area and tissue into which the nerve regenerates. In You Be the Coder of the September issue (page 70), the answer stated in [. ]. The stump neuroma is a natural and expected occurrence after nerve injury. When damaged, the proximal nerve segment attempts to regenerate, leading to a bulb-shaped thickening or stump. Trauma is a common cause for these injuries throughout the body. Question: When our pathologist examines a transmetatarsal amputation specimen, do you think we should code the [. ]. If this is your first visit, be sure to check out the. Scenario: A diabetic patient suffers from gangrene in the fourth and fifth toes of the right foot. The physician performs a ray amputation of these toes and documents that if the ray amputation does not halt the progression of the gangrene, a more aggressive course of treatment may need to be taken. Three weeks later, the gangrene has progressed at a rapid pace and the same physician performs a Chopart amputation of the right foot. The physician documents the previous procedure as unsuccessful at stopping the progression of the tissue death, and a more extensive procedure was warranted. A temporary closure was made and the operative note states the plan is to perform a secondary closure the following week. The patient was returned to the operating room five days later, and an extensive secondary closure was performed. The physician documents that the secondary closure was planned prospectively at the time of the Chopart amputation. Hey Amputation of the foot between the metatarsus and tarsus or tarsometatarsal joint, which is located between the base of the first through fifth metatarsal bones and their connection with the medial, intermediate, and lateral cuneiforms and the cuboid bone in the foot. Partial excision of head of fifth metatarsal bone. You'll need more info in When your pathologist diagnoses an adenomatous polyp submitted from [. ]. Surgeons have utilized epineural sleeves for many years with good success. After transecting the nerve, fold the epineurium back on itself, exposing the underlying fasicles. Sharply transect the fasicles. Then fold back the epineurium distally, covering the exposed fasicles. Close with a minimally reactive 6-0 or smaller suture using a "purse string" stitch technique. The goal is to limit the axonal proliferation into the non-neural connective tissue.14. revision amputation can also considered as amputation so is the code to report metatarsal amputation. hope this will help. There is nothing clinically available that stops nerve regeneration completely. Most surgical treatments are geared toward reducing the abnormal interaction regenerating nerves have with the surrounding connective tissue. When considering surgical intervention for stump neuromas, the first goal is complete excision of the abnormal stump proximally to the level of healthy nerve tissue. Using a sharp scalpel or scissors, one should make a single, uniform, 90-degree cut. Small communicating branches are also present in a certain percentage of the population between the second and third and/or third and fourth common digital nerves. These

4 communicating branches travel transversely, deep to the metatarsals and are usually proximal to the actual Morton's neuroma. When one does not identify this intraoperatively, the terminal nerve stump can become tethered once again and inadequate retraction deep into the foot can occur.9. I recall reviewing some documentation where a patient had a foot amputated, and about two months later the same patient underwent an amputation of the same foot. I thought, "How many times can the same foot be amputated? There's something wrong here.". Scenario: A diabetic patient suffers from gangrene in the fourth and fifth toes of the right foot. The physician performs a ray amputation of these toes and documents that if the ray amputation does not halt the progression of the gangrene, a more aggressive course of treatment may need to be taken. Three weeks later, the gangrene has progressed at a rapid pace and the same physician performs a Chopart amputation of the right foot. The physician documents the previous procedure as unsuccessful at stopping the progression of the tissue death, and a more extensive procedure was warranted. A temporary closure was made and the operative note states the plan is to perform a secondary closure the following week. The patient was returned to the operating room five days later, and an extensive secondary closure was performed. The physician documents that the secondary closure was planned prospectively at the time of the Chopart amputation. Click here for instructions on how to enable JavaScript in your browser. I am glad I didn't say out loud what I was thinking, or I would have ended up with a foot in my mouth, so to speak. As it turns out, my perception of foot amputations was wrong. Not every operation labeled a foot amputation results in the removal of the entire foot; therefore, it is indeed possible for a patient to have multiple amputations at more proximal levels, if a disease progresses RT ( Secondary closure of surgical wound or dehiscence, extensive or complicated ). There is code for partial excision of metatarsal, however, it is a CCI bundle, modifier allowed where appropriate, but being the same foot, and digit, it would not be appropriate, right. Would this be the T5 and that's it? Transmetatarsal Amputation of all toes at the metatarsals. Great (big) toe This little piggy went to market. " Open Mouth, Insert Foot: Partial Foot and Toe Amputations. A partial foot amputation (PFA) may occur in patients with advanced vascular disease secondary to diabetes and its complications, but also may occur due to injury, infection, or birth defect. Numerous complications including skin breakdown, non-healing ulceration, osteomyelitis, and/or gangrene can lead to a subsequent and more proximal amputation. Maryann C. Palmeter, CPC, CENTC, has over 29 years of experience in the health care industry, with emphasis on federal and state government payer billing and compliance regulations. She has gained extensive experience through her work on both the billing and government contractor ends of the health care industry spectrum. Ms. Palmeter is employed with the University of Florida Jacksonville Healthcare, Inc. as the director of physician billing compliance for the University of Florida College of Medicine Jacksonville. She is a member of the AAPC National Advisory Board (NAB) and was named 2010 Member of the Year. Terminal Syme Amputation of part of the distal phalanx, which is performed via an elliptical incision and involves resection of the toenail, nail bed, and approximately half of the distal phalanx. The wound is closed by placing the skin flap over the stump and suturing the skin. Although the skin flap technique is similar to the one used in the Syme amputation of the ankle, do not confuse these two very distinct procedures. Chopart Midtarsal amputation of the foot between the calcaneus and the cuboid bones (Calcaneocuboid joint) and the talus and the navicular bones (Talocalcaneonavicular joint). Don't forget to use modifiers to denote laterality (modifier LT Left side and RT Right side), and to distinguish one toe from another T8 ( ray amputation with application of modifier for forth digit on the right foot ). Use this code to report amputation of distal tuft of phalanges or terminal Syme amputation of the toe. Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; with amputation of tuft of

5 distal phalanx. (Use this code for amputation between the metatarsal joint and proximal phalanx.). Pirogoff Amputation of the foot at the ankle wherein the anterior two thirds of the calcaneus is removed, and the posterior process of the calcaneum is retained at the skin flap and opposed to the cut end of the tibia. Both malleoli are preserved. (Use this code for Hey and Lisfranc amputations, as well.). Use this code for amputation between proximal and middle phalanges or middle and distal phalanges in toes two through five, or amputation between the distal and proximal phalanges in the big toe. Tie Up the Loose Ends of Surgical Wound Coding. The CPT codes to report ankle, foot, and toe amputations are:.