How To Use CPT Code 20838

CPT code 20838 describes the procedure for replantation of a complete amputation of the foot. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 20838?

CPT 20838 is a code used to describe the replantation procedure for a complete amputation of the foot. This procedure involves the reattachment of a severed foot back to the patient’s body. It is a complex surgical procedure that requires the expertise of a qualified healthcare professional.

2. Official Description

The official description of CPT code 20838 is: ‘Replantation, foot, complete amputation.’

3. Procedure

1. The patient is prepped and anesthetized for the procedure.
2. The healthcare provider evaluates and examines the amputated foot, checking for contamination and assessing its vascular supply.
3. The provider preps the amputated foot and debrides any dead tissue and pointed bones.
4. Foreign bodies within the amputated foot are identified and removed.
5. The arteries and veins, or vascular supply, of the amputated foot are freed, identified, and tagged with sutures.
6. An arterial clamp is placed on the patient’s leg to control blood flow during the surgery.
7. The provider fixes the tarsal and metatarsal bones, shortening them if necessary, and applies bone plates or wires to fix the detached bones.
8. The deep flexor and extensor tendons are pulled out from both the patient’s body and the amputated foot and fixed with sutures.
9. The provider performs microvascular anastomosis, reconnecting the corresponding arteries and repairing as many arteries as possible to restore proper vascular flow.
10. If needed, vein grafts may be harvested from other sites to aid in the repair of the amputated foot.
11. The corresponding nerves are pulled out and repaired.
12. The venous supply is repaired in a similar manner, with corresponding veins pulled out and repaired, and vein grafts used if necessary.
13. The foot is checked for proper alignment through forceful extension or flexion.
14. The provider repairs the skin and open wound, using skin grafts or flaps from other body areas if there is major skin loss.
15. The open wound is packed, and an extensive repair of the upper skin surface is performed.
16. The replanted foot is checked again for proper alignment, and a postoperative X-ray may be obtained for confirmation.

4. Qualifying circumstances

CPT 20838 is used for the replantation of a complete amputation of the foot. This procedure is performed when a patient has suffered a traumatic injury resulting in the complete detachment of the foot. The patient must be evaluated by a qualified healthcare professional who determines that replantation is a viable option. The procedure requires the expertise of a skilled surgeon and a team of healthcare professionals.

5. When to use CPT code 20838

CPT code 20838 should be used when a complete amputation of the foot is replanted. This code is specific to the replantation of the foot and should not be used for other types of replantation procedures. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 20838, the healthcare professional must document the following information:

• Details of the patient’s injury and the need for replantation
• Preparation and evaluation of the amputated foot
• Specific steps taken during the procedure, including bone fixation, tendon repair, vascular anastomosis, nerve repair, and skin reconstruction
• Confirmation of proper alignment and postoperative X-ray, if obtained
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 20838, ensure that the procedure performed is a complete amputation replantation of the foot. It is important to follow the specific documentation requirements and accurately code the procedure to support reimbursement. It is also important to review any specific billing guidelines provided by insurance payers to ensure compliance.

8. Historical information

CPT 20838 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code over the years, including its inclusion and removal from the Inpatient Only (IPO) list for Medicare patients.

9. Examples

1. A patient sustains a traumatic injury resulting in a complete amputation of their foot. The healthcare team performs replantation surgery, successfully reattaching the foot to the patient’s body.
2. After a severe accident, a patient arrives at the hospital with a completely amputated foot. The surgical team quickly assesses the patient and proceeds with the replantation procedure, working diligently to restore blood flow and repair the damaged tissues.
3. A young child accidentally severs their foot in a household accident. The healthcare professionals perform a complex replantation surgery, carefully reattaching the foot and ensuring proper alignment for optimal function.
4. A patient undergoes a replantation procedure after a workplace accident results in a complete amputation of their foot. The skilled surgical team works meticulously to repair the damaged blood vessels, nerves, and tendons, aiming to restore full functionality to the replanted foot.
5. Following a traumatic event, a patient arrives at the emergency department with a completely amputated foot. The healthcare team swiftly initiates the replantation procedure, working together to reattach the foot and provide the best possible outcome for the patient.