“A Medicare patient is admitted to the hospital for a foot infection and suspected osteomyelitis of the left, fourth toe. Amputation of the toe is done at the metatarsophalangeal level and billed CPT 28820-T3. However, post-operative x-rays reveal that there is residual bone, presumably from the base of the proximal phalanx that remains. The patient is taken back to surgery a few days later for removal of the residual bone. This was done during the same hospitalization. Would this be coded as CPT 28124-78? Would the -78 modifier not apply since there is no global for the amputation? Could CPT 28124 be billed without a modifier?”
Effective January 1, 2021, the postoperative global period for CPT code 28820 which is defined as “Amputation, toe; metatarsophalangeal joint” changed from “90” days to “0” days. Prior to the change from “90” days to “0” days, if a patient needed to be taken back to the operating room for a related procedure during the postoperative period that was set by the original procedure, specifically CPT code 28820, the subsequent procedure would need to be appended with the 78 modifier which 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 (ie. 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.
So, here we are now in 2022. A patient has an amputation of a toe performed at the metatarsophalangeal joint supporting the billing of CPT code 28820. Since the procedure was performed on the 4th toe of the left foot, the procedure would be billed as CPT 28820 – T3. A “few days” after the initial procedure was performed (ie. CPT code 28820), residual bone from the base of the proximal phalanx of the left, 4th toe needed to be removed and the patient was taken back to the OR for the subsequent procedure to be performed. The most appropriate CPT code to bill for the removal/excision of the residual bone would be CPT code 28124 which is defined as: Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g. osteomyelitis or bossing); phalanx of toe. Since the postoperative global period no longer exists, the only modifier that would need to be appended to the CPT code would be the digital modifier. Therefore, the correct way to code the subsequent procedure is 28124 – T3. By the way, since CPT code 28124 does have a postoperative global period of “90” days, the meter is now running.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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