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CPT 28805 refers to the surgical procedure of transmetatarsal amputation, which involves the removal of the front portion of the foot by cutting across the metatarsal bones. This procedure is typically indicated in cases of severe foot trauma, infection, or other conditions that compromise the viability of the foot. The goal of the surgery is to preserve as much of the foot as possible while ensuring the patient’s overall health and mobility are maintained.
1. What is CPT code 28805?
CPT code 28805 represents the surgical procedure known as transmetatarsal amputation. This procedure is performed when a patient has a condition that necessitates the removal of the forefoot, specifically through the metatarsal bones. The metatarsals are the five long bones located between the tarsal bones of the foot and the phalanges of the toes. Transmetatarsal amputation is often indicated in cases of severe infection, ischemia, or trauma that affects the forefoot, allowing for the preservation of the hindfoot and ankle, which are crucial for mobility. This procedure is significant in the field of podiatry and orthopedic surgery, as it can improve the quality of life for patients by alleviating pain and preventing further complications.
2. Qualifying Circumstances
The use of CPT code 28805 is appropriate under specific clinical circumstances. This code can be utilized when a patient presents with conditions such as diabetic foot ulcers, severe peripheral vascular disease, or traumatic injuries that compromise the integrity of the forefoot. It is essential that the patient is adequately prepared for surgery, including proper anesthesia and surgical consent. Inappropriate use of this code would occur if the amputation is performed at a different level, such as the midtarsal level, which should instead be coded with 28800. Additionally, the decision to perform a transmetatarsal amputation should be based on a thorough evaluation of the patient’s overall health and the potential for rehabilitation post-surgery.
3. When To Use CPT 28805
CPT code 28805 is used when a provider performs a transmetatarsal amputation on a patient. This procedure is indicated when the forefoot is severely compromised, and the decision has been made to remove it to prevent further health complications. It is important to note that this code should not be used in conjunction with other codes that represent different levels of amputation, such as 28800, which is for midtarsal amputation. The provider must ensure that the patient is appropriately prepped and anesthetized before proceeding with the surgery. Documentation should clearly indicate the rationale for the procedure and the condition of the foot to support the use of this specific code.
4. Official Description of CPT 28805
Official Descriptor: Amputation, foot; transmetatarsal.
5. Clinical Application
The clinical context for CPT code 28805 involves the surgical removal of the forefoot through the metatarsal bones. This procedure is critical in managing conditions that threaten the viability of the foot, such as severe infections or traumatic injuries. By performing a transmetatarsal amputation, the surgeon aims to alleviate pain, prevent the spread of infection, and improve the patient’s ability to ambulate post-surgery. The procedure is designed to maintain as much of the foot’s structure as possible, which is essential for future prosthetic fitting and rehabilitation.
5.1 Provider Responsibilities
During the procedure, the provider takes several critical steps. Initially, the patient is prepped and anesthetized to ensure comfort and safety. The provider then makes a circumferential incision around the base of the toes, extending to the metatarsal area. A long skin flap is created to cover the stump after the amputation. The dorsalis pedis artery is ligated to control bleeding, and the nerves are retracted to prevent damage. The provider then transects and divides the muscles and tendons, and may lengthen or transfer some muscles as needed. Finally, the foot is cut transversally through the metatarsal bones, and the front portion of the foot is removed. The wound is then closed by suturing the flaps and packing it with antiseptic gauze to promote healing.
5.2 Unique Challenges
Transmetatarsal amputation presents several unique challenges. One of the primary concerns is ensuring adequate blood supply to the remaining foot structures to promote healing and prevent complications. Additionally, the provider must carefully manage the nerves and muscles to minimize postoperative pain and maximize functional recovery. There is also the challenge of creating a suitable stump for potential prosthetic fitting, which requires precise surgical technique and planning. Postoperative complications, such as infection or delayed healing, can also pose significant challenges in the recovery process.
5.3 Pre-Procedure Preparations
Before performing a transmetatarsal amputation, the provider must conduct a thorough evaluation of the patient’s medical history and current condition. This may include imaging studies to assess the extent of damage to the foot and any underlying vascular issues. The provider should also ensure that the patient is informed about the procedure, its risks, and the expected outcomes. Preoperative assessments may involve consultations with other specialists, such as endocrinologists for diabetic patients, to optimize the patient’s overall health prior to surgery.
5.4 Post-Procedure Considerations
After the procedure, the patient requires careful monitoring and follow-up care. The provider must assess the surgical site for signs of infection and ensure that the stump is healing properly. Pain management is also a critical aspect of post-operative care, as patients may experience discomfort following the amputation. Rehabilitation services may be initiated to help the patient adapt to their new condition, including physical therapy to strengthen the remaining foot and prepare for potential prosthetic fitting. Regular follow-up appointments are essential to monitor the patient’s recovery and address any complications that may arise.
6. Relevant Terminology
Amputation: Surgical removal of a complete or partial appendage of the body.
Dorsalis pedis artery: A blood vessel in the leg that supplies oxygenated blood to the dorsal, or upper, surface of the foot.
Stump: Distal end of the limb left after amputation.
7. Clinical Examples
Example 1: A diabetic patient presents with a non-healing ulcer on the forefoot, leading to the decision for a transmetatarsal amputation to prevent further complications.
Example 2: A patient suffers a traumatic injury to the foot, resulting in extensive tissue damage that necessitates the removal of the forefoot through a transmetatarsal amputation.
Example 3: A patient with severe peripheral vascular disease experiences ischemia in the forefoot, prompting the need for a transmetatarsal amputation to alleviate pain and prevent infection.
Example 4: A patient with osteomyelitis in the metatarsal bones undergoes a transmetatarsal amputation to remove the infected tissue and preserve the rest of the foot.
Example 5: A patient with a history of foot ulcers and neuropathy requires a transmetatarsal amputation to improve mobility and reduce the risk of further complications.
Example 6: A patient presents with a gangrenous toe, and after evaluation, the decision is made to perform a transmetatarsal amputation to prevent the spread of infection.
Example 7: A patient with a severe burn injury to the forefoot undergoes a transmetatarsal amputation to remove the damaged tissue and facilitate healing.
Example 8: A patient with Charcot foot deformity experiences significant pain and instability, leading to the recommendation for a transmetatarsal amputation.
Example 9: A patient with a history of failed foot surgeries presents with chronic pain and infection, resulting in the decision to perform a transmetatarsal amputation.
Example 10: A patient with a congenital foot deformity that has led to recurrent infections is advised to undergo a transmetatarsal amputation to improve function and quality of life.
