Question

What qualifier would be used with an amputation of the 3rd ray at the most proximal portion of the metatarsal?

Answer 1

Its qualifier 1 High: Amputation anywhere along the proximal phalanx

The seventh character defines a qualifier for the code. A qualifier specifies an additional attribute of the procedure, if applicable.
Examples of qualifiers include Diagnostic and Stereotactic. Qualifier choices vary depending on the previous values selected. In this example, there is no specific qualifier applicable to this procedure, so the value is No Qualifier, represented by the letter Z.
Medical and Tendons Excision Lower Arm and Open No Device No Qualifier Surgical Wrist, Right
0LB50ZZ
0LB50ZZ is the complete specification of the procedure "Excision of right lower arm and wrist tendon, open approach."

Complete: Amputation through the carpometacarpal joint of the hand, or through the tarsal- metatarsal joint of the foot
Partial: Amputation anywhere along the shaft or head of the metacarpal bone of the hand, or of the metatarsal bone of the foot
• Qualifier 0 Complete
• Qualifier 4 Complete 1st Ray
• Qualifier 5 Complete 2nd Ray
ICD-10-PCS Reference Manual Page 43

Procedures in the Medical and Surgical section
• Qualifier 6 Complete 3rd Ray
• Qualifier 7 Complete 4th Ray
• Qualifier 8 Complete 5th Ray
• Qualifier 9 Partial 1st Ray
• Qualifier B Partial 2nd Ray
• Qualifier C Partial 3rd Ray
• Qualifier D Partial 4th Ray
• Qualifier F Partial 5th Ray
Thumb, finger, or toe
• Qualifier 0 Complete: Amputation at the metacarpophalangeal/metatarsal-phalangeal joint
• Qualifier 1 High: Amputation anywhere along the proximal phalanx
• Qualifier 2 Mid: Amputation through the proximal interphalangeal joint or anywhere along the middle phalanx
• Qualifier 3 Low: Amputation through the distal interphalangeal joint or anywhere along the distal phalanx
Example: Fifth toe ray amputation
...a semi-elliptical incision was made around the base of the left toe with a #15 blade without difficulty. Careful sharp dissection was made down to the bone, and care was taken to avoid the fourth toe’s neurovascular bundle. There was obvious osteomyelitis of the proximal phalanx of the fifth toe and the toe itself was disarticulated, the proximal head of the fifth lower extremity metatarsal, without difficulty. Specimens were sent to pathology for culture and examination.
Next, both sharp and blunt dissection were used to adequately expose the head of the fifth metatarsal, and this was done without difficulty. A small rongeur was then used to remove the head of the fifth metatarsal, and soft spongy bone was felt beneath this area.
Examination of the patient’s x-rays revealed that there was an area of cortical lucency at the base of the head of the fifth metatarsal, and the decision was made to extend the amputation to the midshaft of the fifth metatarsal, and this was done without difficulty using a rongeur. The wound was then flushed with normal saline, and bleeding viable tissue was observed throughout the wound. There was adequate flap coverage of the remaining fifth metatarsal...
Medical and Lower Detachment Foot, Left Open No Device Partial 5th Ray Surgical Extremities
0Y6N0ZF

Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately represents the procedure performed.
1. Amputation at right elbow level: 0X6B0ZZ
2. Right below-knee amputation, proximal tibia/fibula: 0Y6H0Z1 (The qualifier High here means
the portion of the tib/fib closest to the knee.)
3. Fifth ray carpometacarpal joint amputation, left hand: 0X6K0Z8 (A Complete ray amputation is through the carpometacarpal joint.)
4. Right leg and hip amputation through ischium: 0Y620ZZ (The Hindquarter body part includes amputation along any part of the hip bone.)
5. DIP joint amputation of right thumb: 0X6L0Z3 (The qualifier Low here means through the distal interphalangeal joint,)
6. Right wrist joint amputation: 0X6J0Z0 (Amputation at the wrist joint is actually complete amputation of the hand.)
7. Trans-metatarsal amputation of foot at left big toe: 0Y6N0Z9 (A Partial amputation is through the shaft of the metatarsal bone.)
8. Mid-shaft amputation, right humerus: 0X680Z2
9. Left fourth toe amputation, mid-proximal phalanx: 0Y6W0Z1 (The qualifier High here means
anywhere along the proximal phalanx.)
10. Right above-knee amputation, distal femur : 0Y6C0Z3
Coding note: Qualifier value
The surgeon uses the word "toe" to describe the amputation, but the operative report says he extends the amputation to the midshaft of the fifth metatarsal, which is the foot, so the qualifier is Partial 5th Ray.
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