Domain: Healthcare & Social Assistance
Question:
Pre-operative diagnoses:
1. Traumatic crush injury to left lower leg with non-salvageable tibia and fibula
2. Traumatic partial amputation of right hand involving distal metacarpals
 
Procedure Report:
The patient was emergently transported to the operating room following a high-impact industrial accident. On arrival, the left lower extremity demonstrated extensive comminution of the tibia and fibula with devitalized soft tissue and loss of distal perfusion. After assessment by the surgical team, the limb was deemed non-reconstructable. A through-tibia-and-fibula amputation was performed. The bones were transected at a viable level, non-viable tissue was excised, and the wound was shaped for closure.
Attention was then directed to the right hand, where the patient sustained a traumatic partial amputation involving the distal metacarpal region. Due to the extent of bony and soft-tissue destruction, a formal transmetacarpal amputation was completed. The metacarpal bones were cut at an appropriate level, and the wound edges were contoured for closure.
The patient tolerated the procedures without complication.
 Using only the AMP tab provided, identify the correct CPT code for each procedure described in the operative report. Provide a formal justification for each selection based solely on the definitions and descriptions contained in the AMP section of the spreadsheet.

Expected points in a correct answer:
States that Procedure 1 involves a left lower leg amputation performed through the tibia and fibula.
States that the CPT code assigned to Procedure 1 is 27880.
States that CPT code 27880 description is amputation of the leg through the tibia and fibula.
States that Procedure 1 is classified under the NHSN category AMP.
States that the AMP tab contains a family of procedure codes (CPT 27880-27886) for amputations performed through the tibia and fibula
States that CPT code 27880 represents definitive primary amputation
States that the procedure involves a standard surgical technique with wound shaping of the amputation site.
States that CPT code 27880 does not include immediate prosthetic fitting.
Connects specific operative report details (e.g., bone transection at viable level, wound shaping) to the characteristics of CPT 27880
States that Procedure 2 is a right hand transmetacarpal amputation.
States that the CPT code assigned to Procedure 2 is 25927.
States that the CPT code 25927 description is transmetacarpal amputation.
States that Procedure 2 is classified under the NHSN category AMP.
States that the description is amputation through multiple metacarpal bones of the hand.
States that the plural term "metacarpals" indicates involvement of more than one metacarpal bone.
States that the surgeon's operative note explicitly identifies the procedure as a transmetacarpal amputation.
States that the two procedures differ in anatomical region as reflected in the AMP tab.
States that the two procedures differ in operative purpose as reflected in the AMP tab.
States that the leg amputation procedure involves the lower extremity at the tibia-fibula level.
States that the leg amputation procedure is performed in response to non‑salvageable traumatic injury
States that the transmetacarpal amputation involves the upper extremity at the level of the metacarpal bones.
States that the transmetacarpal amputation procedure is performed due to traumatic destruction of the hand.
States that the AMP tab distinguishes amputation procedures by anatomical structures involved.
States that the AMP tab distinguishes amputation procedures by operative level of amputation
States that CPT 27880 was selected over other codes in the 27880-27886 range because no immediate prosthetic fitting was performed and the procedure was a standard primary amputation.