“The original procedure that was performed was a hallux interphalangeal joint arthroplasty to resolve a medial, diabetic ulcer. An infection developed that led to a hallux amputation. Does the global of the first surgery (arthroplasty) stay in place or is it reset by the zero-day global for the second surgery (amputation)?”
So, a patient had an ulcer on the medial aspect of the great toe. In order to resolve the issue, an arthroplasty was performed at the interphalangeal joint (IPJ) of the hallux. One might think that the appropriate CPT code to bill for this procedure is the gold standard CPT code that is billed for a digital arthroplasty, CPT 28285 which is defined as the following: Correction, hammertoe (e.g. interphalangeal fusion, partial or total phalangectomy). The only problem is that this CPT code is specifically indicated for the correction of a hammertoe deformity, which is not the case here.
I believe that one of the following CPT codes would be best utilized depending upon what exactly was performed at the IPJ of the hallux:
CPT 28124: Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g. osteomyelitis or bossing);
phalanx of toe
CPT 28126: Resection, partial or complete, phalangeal base, each toe
CPT 28153: Resection, condyle(s), distal end of phalanx, each toe
CPT 28160: Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each
All of the above listed CPT codes have a postoperative global period of 90 days. Unfortunately, an infection developed following the procedure necessitating an amputation of the hallux to be performed. The CPT code to be billed for the hallux amputation is CPT 28820 which is defined as the following: Amputation, toe; metatarsophalangeal joint. This CPT code has a postoperative global period of 0 days.
The original postoperative global period of 90 days for the performance of the hallux arthroplasty stays in place despite the performance of the 2nd procedure, the amputation of the hallux. In order to bill for the hallux amputation, CPT 28820 is appended by the 78 modifier. The 78 modifier is defined as the following: UNPLANNED RETURN TO THE OPERATING/PROCEDURE ROOM BY THE SAME PHYSICIAN FOLLOWING INITIAL PROCEDURE FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE PERIOD (COMPLICATION MODIFIER)) – It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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