toe amputation cpt

Toe Amputation CPT (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Toe amputation CPT codes 22820, 28825, and 28810 bills for the service when the physician performs toe amputation such as metatarsophalangeal joint, interphalangeal joint, or metatarsal with single toe, respectively. The physician may remove the partial or complete toe.

Toe Amputation CPT Description

The physician performs an amputation of a toe at the metatarsophalangeal joint or the level of an inter-phalangeal joint. In contrast, toe amputation CPT 28810 bills when a metatarsal bone is attached to the toe. 

The physician performs an incision surrounding the affected area where the toe joins the feet.

The physician makes a deep incision until the metatarsophalangeal or joint interphalangeal joint arises. The skin remains intact around the toe for closure.

The physician identified the capsule and performed capsulotomy, and disjointed the joint. The physician then debrides and excision soft tissues and tendons for skin closure and coverage. 

The physician wholly eradicates the toe from the feet, and the wound irrigates and closes in the physician’s layers. A dressing may apply after the completion of the procedure.

CPT 28810

Toe amputation CPT code 28810 bill for service when the physician performs amputation of the metatarsal with a single toe. 

toe amputation cpt code

CPT 28820

Toe amputation CPT code 28820 bill for service when the physician performs amputation of toe metatarsophalangeal joint

cpt code for amputation of toe

CPT 28825

Toe amputation CPT code 28825 bill for service when the physician performs amputation of toe interphalangeal joint

cpt code for toe amputation

Toe Amputation CPT Reimbursement

A maximum of five units can be a bill on the same service date of toe amputation CPT codes 22820, 28825, or 28810. In contrast, the three units allow documentation supporting the service’s medical necessity.   

The cost and RUVS of CPT 28810 are $465.53 and 13.45232 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 28810 are $465.53 and 13.45232 when performed in the non-facility.

The cost and RUVS of CPT 28820 are $191.98 and 5.54742 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 28820 are $341.21 and 9.85967 when performed in the non-facility.

The cost and RUVS of toe amputation CPT code 28825 are $186.60 and 5.39223 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 28825 are $335.02 and 9.68098 when performed in the non-facility.

Toe Amputation CPT Modifiers

The following are the list modifiers applicable with toe amputation CPT codes 22820, 28825, and 28810 :   

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR.     

Modifier 47 is applicable 22820, 28825, and 28810 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.  

Modifier 76 is appropriate with 22820, 28825, and 28810 when a similar service performs by the Same Physician on the same service date.   

Modifier 54 is applicable with 22820, 28825, and 28810 when the physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to 22820, 28825, and 28810 when the physician performs post-management and preoperative care only.   

Modifier 76 is applicable with 22820, 28825, and 28810 when a similar service performs by a different Physician on the same service date.   

Modifier 59 is applicable with 22820, 28825, and 28810 when a Distinct service performs by the physician and bundled with another procedure on the same date.     

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with 22820, 28825, and 28810 when service bills to Medicare insurance. It divides the modifier into four parts for further specification of the procedure.   

Modifier 53 will be reported with 22820, 28825, and 28810 if an unsuccessful attempt for an amputation toe makes due to unavoidable circumstances like allergic reactions to the substance.   

Modifier 22 applies to 22820, 28825, and 28810 when services perform longer than usual and take extra resources during the procedure.   

Modifier 23 is applicable with 22820, 28825, and 28810 when general or local anesthesia administers by the physician and routinely does not require during the procedure.   

Modifier 52 applies when the physician does not complete the amputation service and terminates due to unavoidable circumstances.   

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and 22820, 28825, and 28810 must apply the GA modifier to that service.

Toe Amputation CPT Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

Suppose any evaluation and management service performs in conjunction with toe amputation CPT codes 22820, 28825, and 28810 on the same day, one day before surgery, or in the postoperative period for an unrelated condition. In that case, it is appropriate to report E/M codes 99201-99499 with modifier 25.

CPT 28810 has 90 days global period. Suppose the physician performs any service related to 28810 in the postoperative period. It is appropriate to report separately. 

Suppose multiple amputations perform by the physician, report 28810 for each one, and append modifier 59 or an X{EPSU} modifier to additional codes. When 28810 performs with another separately identifiable procedure, the highest dollar value code lists as the primary procedure, and subsequent services attach with modifier 51.

According to CPT guidelines, cast application or strapping (including removal) reports as a replacement procedure or when the cast application or strapping is an initial service performed without a curative treatment or procedure. See “Application of Casts and Strapping” in the CPT book in the Surgery section, under Musculoskeletal System. For amputation, metatarsal with toe, see 28810. For partial amputation of a metatarsal bone (trans-metatarsal), see 28805.

Toe Amputation CPT Examples

The Following are the example when toe amputation CPT codes 28820, 28825, or 28810 bills:

Example 1  

A 44-year-old male patient was admitted to ABCD General Hospital on 12/07/2008 with a diagnosis of osteomyelitis of the left hallux and cellulitis of the left lower extremity. 

The patient has a history of diabetes and has had chronic ulceration to the right hallux and has been on outpatient antibiotics, which he failed. After multiple conservative treatments such as wound care antibiotics, the patient was given the option of amputation as a treatment for chronic resistant osteomyelitis.

The patient wants to try a surgical correction. The consent obtains from the patient. 

The physician schedules the amputation procedure for the next week and prescribes medication. Dr. ABC discussed the risks versus benefits of the service with the patient in detail. 

Example 2

A 33-year-old male patient was admitted to ABCD General Hospital on xx/xx/XXXX with a diagnosis of a right foot ulcer due to diabetes. 

The patient has a history of diabetes and has had chronic ulceration to the right foot and has been on outpatient antibiotics, which he failed.

After multiple conservative treatments such as wound care antibiotics, the patient was given the option of amputation as a treatment for a right foot ulcer.

 The patient wants to try a surgical correction. The consent obtains from the patient. Dr. ABC discussed the risks versus benefits of the procedure with the patient in detail. 

The physician schedules the amputation procedure for the next week and prescribes medication. 

Example 3

A 76-year-old male patient admits to ABCD General Hospital on xx/xx/XXXX with a diagnosis of Malignant neoplasm right lower limb. The patient denies any other extremity pain and swelling. 

The patient has a history of diabetes and has neoplasm of the right lower limb and has been on outpatient antibiotics, which he failed.

After multiple conservative treatments such as wound care antibiotics, the patient was given the option of amputation as a treatment for Malignant neoplasm right lower limb.

The patient wants to try a surgical correction. The consent obtains from the patient. Dr. ABC discussed the risks versus benefits of the procedure with the patient in detail. 

The physician schedules the amputation procedure for the next week and prescribes medication. 

Example 4

A 57-year-old male patient was admitted to ABCD General Hospital on XX/XX/XXXX with a diagnosis of Atherosclerosis of native arteries, left leg with ulceration of heel and midfoot.

The patient has a history of diabetes and has had chronic ulceration to the right hallux and has been on outpatient antibiotics, which he failed. After multiple conservative treatments such as wound care antibiotics, the patient was given the option of amputation as a treatment for Atherosclerosis of the native arteries left leg.

The patient wants to try a surgical correction. The consent obtains from the patient. Dr. ABC discussed the risks versus benefits of the procedure with the patient in detail.

The physician schedules the amputation procedure for the next week and prescribes medication. 

Example 5

A 44-year-old male patient was admitted to ABCD General Hospital on XX/XX/XX with a diagnosis of Crushing injury of the right toe, and the wound is not heeling. The Infection is spreading to the other parts.

The patient has a history of diabetes and has had a Crushing injury to the right toe and has been on outpatient antibiotics, which he failed. After multiple conservative treatments such as wound care antibiotics, the patient was given the option of amputation as a treatment for Crushing injury of the right toe.

The patient wants to try a surgical correction. The consent obtains from the patient. 

The physician schedules the amputation procedure for the next week and prescribes medication. Dr. ABC discussed the risks versus benefits of the service with the patient in detail. 

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