Digit or Toe Amputation

CPT 28820
Approach Open
Add-on / Variant CPTs
  • 28825 — Amputation, toe, partial proximal phalanx
  • 28810 — Amputation, foot, midtarsal (Chopart) joint
  • 28153 — Resection, metatarsal head (ray resection)
Preoperative Diagnosis:

[Diabetic foot infection / osteomyelitis / gangrene / trauma], [right / left] [great / second / third / fourth / fifth] toe

Postoperative Diagnosis:

Same

Procedure Performed:

[Disarticulation / amputation] of [right / left] [great / second / third / fourth / fifth] toe at [metatarsophalangeal joint / proximal phalanx]

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/PA name]

Anesthesia:

[General / spinal / ankle block / local with sedation]

Indications:

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.

Findings:

[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.]

Description of Procedure:

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 / proximal phalanx] 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.

Complications:

None

Specimens:

[Digit and/or bone sent to pathology and microbiology / Intraoperative bone cultures sent]

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

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 / 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
.TODAY
Variants

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. Code with 28153 for metatarsal head resection.

Transmetatarsal amputation (TMA)

For forefoot gangrene or multilevel toe involvement. CPT 28805. Document level of bone transection, beveling for weight distribution, and closure with plantar flap.

Finger disarticulation (hand)

Use hand CPT codes (26951 for disarticulation at PIP/DIP, 26910 for MCP). Document digital nerve level and tendon management for functional outcome and pain control.

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 ABI or vascular assessment preoperatively for diabetic/PAD patients
Billing Tips
  • Bill 28820 for amputation of a toe at the metatarsophalangeal joint (3.42 wRVU, 0-day global). Bill 28810 for amputation of foot at the midtarsal (Chopart) joint. Bill 28825 for partial amputation of a toe, proximal phalanx. Code selection depends on the level of amputation, so document the exact anatomic level.
  • Ray amputation (removal of toe plus metatarsal head or segment) is coded differently: 28153 for resection of metatarsal head, or 28810 for midfoot-level amputation. If the metatarsal is partially or fully removed along with the toe, clarify in the operative note, as this affects code selection.
  • For finger amputations (hand surgery), use 26951 (disarticulation at PIP/DIP joint) or 26910 (amputation at metacarpophalangeal joint). These are separate code families from toe codes. Do not mix foot and hand codes.
  • 0-day global period: no postoperative care is bundled. Wound checks, dressing changes, and follow-up visits are separately billable using E/M codes with modifier -24 (unrelated) or -79 (unrelated procedure). Document medical necessity for each visit.
  • Wound closure or flap creation at the time of amputation is typically included in the amputation code. Separate billing for closure or skin grafting is only appropriate if a distinct, additional procedure is performed beyond routine stump closure.