Digit or Toe Amputation
2882028825wRVU: 3.32 — Amputation, toe, at interphalangeal joint (3.32 wRVU, 0-day global) — joint disarticulation, not bone-level transection28810wRVU: 6.47 — Amputation, toe with metatarsal, single ray (6.47 wRVU, 90-day global)28111wRVU: 5.02 — Ostectomy, complete excision, first metatarsal head only (5.02 wRVU, 90-day global) — use 28112 for 2nd/3rd/4th, 28113 for 5th28112wRVU: 4.51 — Ostectomy, complete excision, 2nd/3rd/4th metatarsal head (4.51 wRVU, 90-day global)28113wRVU: 5.96 — Ostectomy, complete excision, 5th metatarsal head (5.96 wRVU, 90-day global)28153wRVU: 3.71 — Resection, condyle or distal phalanx, toe (3.71 wRVU)
[Diabetic foot infection / osteomyelitis / gangrene / trauma], [right / left] [great / second / third / fourth / fifth] toe
Same
[Disarticulation / amputation] of [right / left] [great / second / third / fourth / fifth] toe at [metatarsophalangeal joint / proximal phalanx]
[Attending name], MD
[Resident/PA name]
[General / spinal / ankle block / local with sedation]
Patient presents with [gangrenous / infected / ischemic] [right / left] [great / second] toe in the setting of [diabetes mellitus / peripheral arterial disease / osteomyelitis / crush injury]. [Vascular surgery consulted; revascularization not an option / wound care failed to heal / bone biopsy confirmed osteomyelitis.] Ankle-brachial index [X]. Risks including wound dehiscence, proximal spread of infection, re-amputation at higher level, and perioperative complications discussed with patient and family. Consent obtained.
[Gangrenous / infected / ischemic] changes affecting [toe / metatarsal head]. [Bone exposed / purulence noted / surrounding cellulitis.] [Metatarsal head viable / metatarsal head involved and resected.] [Intraoperative bone biopsy sent / cultures sent.]
The patient was positioned supine with the operative extremity prepped and draped in sterile fashion. [A thigh tourniquet was inflated to [X] mmHg / No tourniquet used given vascular compromise.]
A [racquet / fish-mouth / longitudinal] incision was planned at the [metatarsophalangeal joint level / proximal phalanx level]. The skin and soft tissues were incised. The extensor and flexor tendons were identified, transected, and allowed to retract. The joint capsule was entered and the toe [disarticulated at the MTP joint / amputated through the proximal phalanx (transection, not disarticulation)] using a scalpel and rongeur. [The metatarsal head was assessed: [viable and preserved / irregular and resected with rongeur to viable bleeding cortical bone].]
Intraoperative cultures were sent. The wound was irrigated copiously with [3 L / X L] normal saline. [Bone edges were smoothed with a rongeur.] [Primary closure performed with [2-0 Vicryl] for deep layer and [3-0 Nylon] for skin / Wound left open for secondary intention healing given contamination.] A [bulky / saline-soaked] dressing was applied.
[Tourniquet released. Hemostasis confirmed.] Patient tolerated the procedure well.
None
[Digit and/or bone sent to pathology and microbiology / Intraoperative bone cultures sent]
Minimal
None
Patient taken to PACU in stable condition. Admitted for postoperative wound care and antibiotics.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: [Diabetic foot infection / gangrene / osteomyelitis], [right / left] [great / second / third] toe
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: [Disarticulation / amputation] of [right / left] [great / second / third / fourth / fifth] toe at metatarsophalangeal joint
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: [General / spinal / ankle block]
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with [gangrenous / infected / ischemic] changes of the [right / left] [great / second] toe in the setting of [diabetes mellitus / peripheral arterial disease / osteomyelitis]. [Vascular surgery evaluated; revascularization not feasible.] ABI: ***. Risks including wound dehiscence, proximal spread of infection, and need for re-amputation were discussed. Informed consent obtained.
FINDINGS: [Gangrenous / infected] changes to [toe / metatarsal head]. [Bone exposed / purulence present.] Metatarsal head [viable and preserved / involved and resected to viable bone]. Cultures sent.
DESCRIPTION OF PROCEDURE:
Patient supine; [right / left] extremity prepped and draped sterile. [Thigh tourniquet inflated to *** mmHg / No tourniquet; vascular compromise.] [Racquet / fish-mouth] incision at MTP joint level. Skin and soft tissues incised; extensor and flexor tendons transected and allowed to retract. Joint capsule entered; toe [disarticulated at MTP joint / amputated through proximal phalanx] with scalpel and rongeur. [Metatarsal head assessed: viable and preserved / resected to viable cortical bone.] Bone cultures and [tissue for pathology] sent. Wound irrigated with *** L normal saline. [Primary closure with 2-0 Vicryl deep layer and 3-0 Nylon skin / Left open given contamination.] Dressing applied. [Tourniquet released; hemostasis confirmed.] Patient tolerated the procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: Digit and bone to pathology and microbiology
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to PACU in stable condition. Admitted for wound care and antibiotics.
Signed: .ME, .MYDEGREE
.TODAYVariants
Ray amputation
Includes partial or complete metatarsal resection with the toe. Document extent of metatarsal removed, closure technique, and whether adjacent weight-bearing is preserved. CPT 28810 (6.47 wRVU, 90-day global). For isolated metatarsal head resection without toe amputation, use 28111 (first metatarsal only), 28112 (2nd/3rd/4th), or 28113 (5th).
Transmetatarsal amputation (TMA)
For forefoot gangrene or multilevel toe involvement. CPT 28805 (12.39 wRVU, 90-day global). Document level of bone transection, beveling for weight distribution, and closure with plantar flap.
Finger disarticulation (hand)
CPT 26951 (5.89 wRVU, 90-day global) covers amputation at any joint OR through any phalanx with direct closure — not limited to PIP/DIP disarticulation. CPT 26952 (6.32 wRVU) is the same procedure with local advancement flap (V-Y or hood flap). CPT 26910 (7.60 wRVU) is ray amputation — metacarpal with digit. Document digital nerve transaction level and tendon management.
Charting Tips
- Document exact amputation level (metatarsophalangeal joint, proximal/mid/distal phalanx)
- State tourniquet use (or explain why not used in vascular patients)
- Note metatarsal head viability and whether it was preserved or resected
- Send bone for pathology and cultures separately when osteomyelitis is suspected
- Document wound closure method (primary vs. open) and rationale if left open
- Note vascular assessment preoperatively. ABI is unreliable in diabetics with calcified vessels (falsely elevated). Toe pressures, TcPO2, or SPP are preferred when ABI is >1.3 or wound healing is questionable. Document which modality was used and the result.
- Medicare claims for 28820, 28825, and 28810 require HCPCS T-modifiers identifying the specific toe (TA = left great; T1–T4 = left 2nd–5th; T5 = right great; T6–T9 = right 2nd–5th). Failure to append the T-modifier is a common denial cause.
Billing Tips
- Select code by amputation level: 28820 (MTP joint disarticulation, 3.42 wRVU, 0-day global); 28825 (amputation at the interphalangeal joint, 3.32 wRVU, 0-day global — NOT 'proximal phalanx'; this is a joint disarticulation); 28810 (ray amputation — toe with metatarsal, 6.47 wRVU, 90-day global); 28800 (Chopart/midfoot, 8.57 wRVU, 90-day global); 28805 (transmetatarsal, 12.39 wRVU, 90-day global).
- Ray amputation (toe with metatarsal) uses 28810 (6.47 wRVU, 90-day global). For isolated metatarsal head resection without toe amputation: 28111 (FIRST metatarsal head only, 5.02 wRVU), 28112 (2nd/3rd/4th metatarsal head, 4.51 wRVU), or 28113 (5th metatarsal head, 5.96 wRVU). Diabetic forefoot cases commonly involve 2nd–5th metatarsals — do not use 28111 for non-first metatarsal resections.
- Global period: 28820 and 28825 have a 0-day global (changed from 90-day effective January 2021). 28810, 28800, and 28805 retain 90-day global periods. With a 0-day global, routine postoperative E/M visits are billed normally without global-period modifiers. Modifiers -24 and -79 apply within 90-day global periods, not 0-day globals.
- Medicare requires HCPCS T-modifiers to identify the specific toe: TA = left great toe; T1–T4 = left 2nd–5th toes; T5 = right great toe; T6–T9 = right 2nd–5th toes. Claims for 28820, 28825, and 28810 are frequently denied without the correct T-modifier.
- For finger amputations (hand surgery): 26951 (amputation at any joint or phalanx, direct closure, 5.89 wRVU, 90-day global) or 26952 (same with local advancement flap, 6.32 wRVU); 26910 (ray amputation — metacarpal + finger, 7.60 wRVU). Do not mix hand and foot codes.
General coding reference. Verify with your institution’s billing department before submitting claims.