© Copyright 2025 American Medical Association. All rights reserved.
Amputation through the malleoli of the tibia and fibula, specifically procedures such as Syme or Pirogoff, involves the surgical removal of the foot at the ankle joint. This procedure is typically indicated for patients suffering from severe injuries, vascular insufficiency, or infections affecting the forefoot. The term "malleoli" refers to the bony prominences on either side of the ankle, which are critical landmarks during the surgical process. The procedure begins with careful marking of incision lines on the skin to ensure precision. Following this, the surgeon incises the skin and underlying soft tissues, allowing access to the deeper structures. Dissection continues down to the muscle layers, where muscle compartments are identified, isolated, and divided to facilitate the removal of the foot. During this process, neurovascular structures, including nerves and blood vessels, are meticulously identified and isolated. It is crucial to separate the nerves from the arteries to prevent any pulsatile irritation that could lead to complications. The surgical team then excises the forefoot, midfoot, talus, and calcaneus while taking care to preserve the heel pad, which is essential for post-operative weight-bearing. The procedure also involves incising the periosteum of the tibia and fibula just below the malleoli, followed by the elevation of lateral and medial osteoperiosteal flaps. The bone is subsequently resected, and the periosteal flaps are sutured over the remaining tibia and fibula. Finally, the plantar fat and skin pad are rotated and sutured over the end of the tibia and fibula, creating a sensate weight-bearing surface that aids in the patient's recovery and rehabilitation.
© Copyright 2025 Coding Ahead. All rights reserved.
The amputation through the malleoli of the tibia and fibula is performed for several specific indications, which include:
The procedure for amputation through the malleoli of the tibia and fibula involves several critical steps, which are detailed as follows:
Post-procedure care following an amputation through the malleoli of the tibia and fibula includes monitoring for any signs of infection, managing pain, and ensuring proper wound healing. Patients may require rehabilitation services to adapt to the loss of the foot and to learn how to use prosthetics if applicable. Follow-up appointments are essential to assess the healing process and to address any complications that may arise. The surgical site should be kept clean and dry, and patients are advised on activity restrictions to promote optimal recovery.
| Short Descr | AMPUTATION OF FOOT AT ANKLE | Medium Descr | AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV | Long Descr | Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nerves | 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. | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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.) | 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) |
|
Date
|
Action
|
Notes
|
|---|---|---|
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.