How To Use CPT Code 28800

CPT 28800 describes the surgical procedure known as midtarsal amputation, specifically involving the foot. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28800?

CPT 28800 is a code used to describe a surgical procedure called midtarsal amputation. This procedure involves the amputation of the foot just in front of the heel and ankle, specifically at the midtarsal joints. These joints, also known as transverse tarsal joints, are the combined joints of either the talus with the navicular bone or the calcaneum with the cuboid bone.

2. Official Description

The official description of CPT code 28800 is: ‘Amputation, foot; midtarsal (eg, Chopart type procedure).’ This code specifically refers to the surgical removal of the foot at the midtarsal joints, which involves the talonavicular and calcaneocuboid joints.

3. Procedure

1. During the procedure, the healthcare provider begins by making an incision in the skin just distal to the talonavicular joint, in front of the ankle.
2. They then create skin flaps that will be used to cover the stump after the amputation.
3. The provider ligates the dorsalis pedis artery and retracts the nerves.
4. Next, they divide the capsule of the talonavicular joint and release the posterior tibial tendon.
5. The Achilles tendon is lengthened and attached to the neck of the talus bone to support the function of the tibialis anterior and posterior tendons.
6. Other tendons may be divided, lengthened, or transferred as necessary to prevent contracture post-amputation.
7. The provider then incises the ligaments covering the talonavicular and calcaneocuboid joints and separates the foot through these joints.
8. Finally, after irrigating the wound with antibiotics, the provider closes the wound by suturing the flaps and packs it with antiseptic gauze.

4. Qualifying circumstances

CPT 28800 is performed on patients who require a midtarsal amputation due to various medical conditions or injuries. It is typically indicated when there is a need to remove the foot just in front of the heel and ankle, specifically at the midtarsal joints. The procedure may be necessary for conditions such as severe trauma, tumors, infections, or other diseases affecting the foot. It is important to note that the decision to perform this procedure should be made by a qualified healthcare professional based on the patient’s individual circumstances.

5. When to use CPT code 28800

CPT code 28800 should be used when a midtarsal amputation is performed on a patient. It is important to accurately document the specific procedure performed and ensure that it aligns with the official description of CPT 28800. This code should not be used for amputations performed at different levels or involving different joints of the foot.

6. Documentation requirements

To support a claim for CPT 28800, the healthcare provider must document the following information:

• Patient’s diagnosis or reason for the midtarsal amputation
• Details of the procedure performed, including the specific joints involved
• Date of the procedure
• Any additional procedures or interventions performed during the same operative session
• Any complications or unexpected findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 28800, it is important to ensure that the procedure performed aligns with the official description of the code. The healthcare provider should also follow any specific billing guidelines provided by the payer or coding guidelines. It is important to accurately document the procedure and any additional services provided during the same operative session. Additionally, it is crucial to use the appropriate modifiers, if required, to indicate any specific circumstances or additional services provided.

8. Historical information

CPT 28800 was added to the Current Procedural Terminology system on January 1, 1990. Over the years, there have been some changes in its status, including being added and removed from the Inpatient Only (IPO) list for Medicare. It is important to stay updated with any changes or updates related to this code.

9. Examples

1. A patient with severe trauma to the foot undergoes a midtarsal amputation to remove the damaged tissue and preserve functionality.
2. A patient with a malignant tumor in the foot requires a midtarsal amputation to remove the affected area and prevent further spread of the cancer.
3. A patient with a severe infection in the foot undergoes a midtarsal amputation to remove the infected tissue and prevent the spread of the infection.
4. A patient with a chronic disease affecting the foot, such as peripheral vascular disease, may require a midtarsal amputation to improve blood flow and alleviate symptoms.
5. A patient with a congenital deformity in the foot undergoes a midtarsal amputation to correct the structural abnormalities and improve functionality.
6. A patient with a severe foot injury, such as a crush injury or severe burn, may require a midtarsal amputation to remove the damaged tissue and promote healing.
7. A patient with a non-healing foot ulcer that is unresponsive to other treatments may undergo a midtarsal amputation to remove the non-healing tissue and promote wound healing.
8. A patient with a severe foot infection, such as osteomyelitis, may require a midtarsal amputation to remove the infected bone and tissue and prevent further complications.