How To Use CPT Code 28820

CPT 28820 refers to the amputation of a toe at the metatarsophalangeal joint. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 28820 procedures.

1. What is CPT 28820?

CPT 28820 is a medical procedure code used to describe the amputation of a toe at the metatarsophalangeal joint. This code is utilized by medical coders and billers to accurately document and bill for this specific surgical procedure.

2. 28820 CPT code description

The official description of CPT code 28820 is: “Amputation, toe; metatarsophalangeal joint.”

3. Procedure

The 28820 CPT code procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the skin over the metatarsophalangeal joint from where he will remove the toe.
3. He dissects down through subcutaneous tissue to access the metatarsophalangeal joint.
4. He next incises the capsule and separates the proximal phalanx from the metatarsal.
5. He ligates the blood vessels and retracts the nerves.
6. He then transects and divides the muscles’ tendons.
7. He finally resects or cuts the entire toe at the metatarsophalangeal joint.
8. After irrigation of the wound with antibiotics, he closes the wound by suturing the flaps and packs the wound with antiseptic gauze.

4. Qualifying circumstances

Patients eligible to receive CPT code 28820 services are those who have a medical condition that necessitates the amputation of a toe at the metatarsophalangeal joint. Such conditions may include severe infection, gangrene, trauma, or other conditions that compromise the viability of the toe and pose a risk to the patient’s overall health. The decision to perform this procedure is typically made by a qualified healthcare provider after a thorough evaluation of the patient’s medical history, current condition, and other relevant factors.

5. When to use CPT code 28820

It is appropriate to bill the 28820 CPT code when a provider performs an amputation of a toe at the metatarsophalangeal joint due to a qualifying medical condition. This code should be used to accurately document and bill for the specific surgical procedure performed.

6. Documentation requirements

To support a claim for CPT 28820, the following information should be documented in the patient’s medical record:

• A detailed medical history, including the patient’s presenting symptoms and any relevant past medical, surgical, or family history.
• A thorough physical examination, including an assessment of the affected toe and surrounding structures.
• Diagnostic tests and imaging studies, if applicable, that support the decision to perform the amputation.
• A clear and concise operative report, detailing the surgical procedure performed, including the specific steps taken during the amputation and any complications encountered.
• Postoperative care instructions and follow-up plans, including any necessary referrals or additional treatments.

7. Billing guidelines

When billing for CPT code 28820, it is essential to follow the appropriate billing guidelines and rules. These may include:

• Ensuring that the procedure is medically necessary and supported by the patient’s medical record.
• Verifying that the documentation requirements outlined above are met.
• Confirming that the CPT code 28820 is the most accurate code to describe the specific procedure performed.
• Checking for any applicable modifiers that may need to be appended to the CPT code to provide additional information about the procedure.
• Reviewing payer-specific guidelines and policies to ensure compliance with their requirements.

8. Historical information

CPT 28820 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the descriptor since its addition.

9. Similar codes to CPT 28820

Five similar codes to CPT 28820 and how they differentiate from CPT 28820 are:

• CPT 28810: This code is used when the provider amputates the toe along with the metatarsal.
• CPT 28825: This code is used when the provider amputates the toe at an interphalangeal joint.
• CPT 28805: This code is used when the provider performs a disarticulation of the metatarsophalangeal joint without amputation of the toe.
• CPT 28899: This code is used for unlisted procedures on the foot or toes, which do not fit into any other specific CPT codes.
• CPT 28080: This code is used when the provider performs an excision of a lesion of the foot or toe, without amputation.

10. Examples

Here are 10 detailed examples of CPT code 28820 procedures:

1. A patient with severe diabetic foot infection requiring amputation of the great toe at the metatarsophalangeal joint.
2. A patient with gangrene of the second toe due to peripheral arterial disease, necessitating amputation at the metatarsophalangeal joint.
3. A patient with a traumatic injury to the third toe, resulting in the need for amputation at the metatarsophalangeal joint.
4. A patient with a non-healing ulcer on the fourth toe, leading to infection and the need for amputation at the metatarsophalangeal joint.
5. A patient with a malignant tumor on the fifth toe, requiring amputation at the metatarsophalangeal joint for oncologic purposes.
6. A patient with severe osteomyelitis of the first toe, necessitating amputation at the metatarsophalangeal joint to control the infection.
7. A patient with a severe burn injury to the second toe, resulting in tissue necrosis and the need for amputation at the metatarsophalangeal joint.
8. A patient with a chronic, non-healing wound on the third toe, leading to infection and the need for amputation at the metatarsophalangeal joint.
9. A patient with a severe deformity of the fourth toe, causing significant pain and functional impairment, necessitating amputation at the metatarsophalangeal joint.
10. A patient with a history of multiple failed surgeries on the fifth toe, resulting in chronic pain and the need for amputation at the metatarsophalangeal joint.