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Amputation through the tibia and fibula, commonly known as a below-knee (BK) amputation, is a surgical procedure that involves the removal of the leg below the knee joint. This procedure is one of the most frequently performed major limb amputations. The process begins with the careful marking of incision lines on the skin to guide the surgeon in performing the amputation. The surgeon incises the skin and underlying soft tissues, followed by dissection down to the muscle layers. During this dissection, the muscle compartments are identified, isolated, and divided to facilitate access to the neurovascular structures. These structures include the tibial nerve, artery, and vein, as well as the superficial and deep peroneal nerves and their corresponding arteries and veins, the sural nerve, and the saphenous nerve and vein. To prevent complications, such as pulsatile irritation of the nerves, the surgeon meticulously isolates the nerves from the arteries. The nerves are then transected as high as possible, allowing them to retract into the surrounding soft tissues. The procedure continues with the incision of the periosteum of the tibia and fibula, followed by the elevation of lateral and medial osteoperiosteal flaps. The bones are subsequently resected to complete the amputation. After the bone resection, the medial tibial flap is sutured to the lateral fibular flap, and the lateral tibial flap is sutured to the medial fibular flap, creating a protective bridge over the ends of the bones. The mobilized muscles are then configured into flaps and brought over the ends of the tibia and fibula, with opposing muscles sutured together to promote healing. Finally, skin flaps are fashioned and sutured over the muscle to close the surgical site. Following the healing of the wound, the patient is fitted for a prosthesis. The specific code 27881 is used when a cast of the stump is obtained, and the patient is immediately fitted for a prosthesis, ensuring proper support and alignment during the recovery process.
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The procedure of amputation through the tibia and fibula is indicated for various conditions that may necessitate the removal of the lower leg. These indications include:
The procedure for amputation through the tibia and fibula involves several critical steps, each designed to ensure a safe and effective outcome. The steps include:
After the amputation procedure, the patient will require careful monitoring and post-operative care. This includes managing pain, preventing infection, and ensuring proper wound healing. The patient will typically be fitted for a prosthesis following the healing of the surgical site. The use of code 27881 indicates that a cast of the stump is obtained, and the patient is immediately fitted for a prosthesis, which is crucial for rehabilitation and mobility. Regular follow-up appointments will be necessary to assess the healing process and make any adjustments to the prosthesis as needed.
| Short Descr | AMPUTATION OF LOWER LEG | Medium Descr | AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST | Long Descr | Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 157 - Amputation of lower extremity |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: 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/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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