Q: How is a double osteotomy bunionectomy coded? Does it require more than one code?
A: The intent of a double osteotomy is to make two cuts in the bone – either two in the metatarsal head or one in the metatarsal head and one in the proximal phalanx – to correct angulation deformity. When you apply the root operation definitions to this procedural intent, the root operation is Reposition. The body part being repositioned is the toe, so regardless of the number of osteotomies performed, only a single reposition code is needed.

Q: How is a transmetarsal amputation of the foot coded when all five metatarsals are cut through?
A: ICD-10-PCS includes qualifiers for partial foot amputation of each metatarsal, so this would require five codes, each with a unique qualifier to indicate the partial ray that was amputated.

Q: How is debridement of an amputation stump coded?
A: Debridement of the amputation stump is coded based on the type of tissue removed and the method of removal. Excisional debridement involving cutting of tissue with a sharp instrument, is coded to the root operation Excision. Nonexcisional debridement is coded to the root operation Extraction. Medical record documentation should explicitly state the tissue that was removed (e.g., bone, tendon, subcutaneous tissue). (And only code for the deepest - Overlapping body layers B3.5 )

**The coding information and guidance in this post are valid at the time of publishing. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Consultant

Kristi is a senior consultant with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.

Kristi has served the Colorado Health Information Management Association (CHIMA) as board Director, co-chair of the Data Quality Committee, and co-chair for the ICD-10 Task Force. She is also a past president of the Northern Colorado Health Information Management Association (NCHIMA). Kristi is the proud recipient of the 2011 AHIMA Triumph Award for Mentoring for her voluntary work as the “Coder Coach.” She has also received awards from CHIMA for Distinguished Member (2018) and Outstanding Volunteer (2013) and from AHIMA for Roundtable Achievement in Coding Excellence (RACE).


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