below knee amputation cpt code

[2], Thesecond Trans-Atlantic Inter-Society Consensus Working Group (TASC II) reported the incidence of major amputations due to peripheral artery disease for up to 50 per 100,000 individuals annually. ICD-10: Routine Aftercare Following Amputation (Coding Tip by PPS Plus) - Feb 2016. After BKA, floor nursing plays a significant role in managing pain, recording drain outputs, and informing the covering physicians of any change in vital signs or overall status. A 25-year-old male presents to the emergency department with a mangled lower extremity that is not salvageable. How far below the knee is that? supports all conditions were evaluated. For an above knee amputation, each of the following is a benefit of adductor myodesis EXCEPT: Allows preservation of greater femoral length, Provides a soft tissue cushion beneath the osseous amputation, Improves the position of the femur to allow more efficient ambulation, Creates dynamic balance of the amputated femur. Beyaz S, Gler , Bar G. Ultrasound may likewise evaluate localized collections. Which of the following amputations will lead to the greatest oxygen requirement per meter walked following prosthesis fitting? (OBQ04.235) As a result, his energy expenditure while ambulating is 40% above baseline after being fitted with an appropriate prosthetic prescription. The frequency of ICD 10 codes used to define upper gastrointestinal. Phair J, DeCarlo C, Scher L, Koleilat I, Shariff S, Lipsitz EC, Garg K. Risk factors for unplanned readmission and stump complications after major lower extremity amputation. Once the wound is healing well, a stump shrinker may be placed, providing circumferential compression around the stump and distal extremity. &JQ%hAQx4HA e=;f h7[mSv47zx{9z}U/wz/XmM=5ffK> =s}TOn6mz2)94}n4Y5KTZfcV(-- /+ (OBQ10.162) Lower limb ischemia, peripheral arterial disease, and diabetes mellitus are considered the major causality of limb amputations in more than 50 % of cases. The applicable bodypart is lower leg, left. Lower limb ischemia, peripheral arterial disease, and diabetes mellitus are considered the major causality of limb amputations in more than 50 % of cases. Distally, branches from nerves supplying the overlying muscle innervate the tibia below. Wang K, Ye Y, Huang L, Wu R, He R, Yao C, Wang S. The Long Non-coding RNA AC148477.2 Is a Novel Therapeutic Target Associated With Vascular Smooth Muscle Cells Proliferation of Femoral Atherosclerosis. ICD-10-CM Diagnosis Code S78.121A [convert to ICD-9-CM] Partial traumatic amputation at level between right hip and knee, initial encounter Partial traumatic amp at level betw right hip and knee, init; Partial traumatic right above knee amputation; Traumatic partial right above knee amputation ICD-10-CM Diagnosis Code S78.122A [convert to ICD-9-CM] It persists despite a well-fitted prosthesis. y:ma! Factors affecting lifespan following below-knee amputation in diabetic patients. endstream endobj 731 0 obj <>]/Filter[/DCTDecode]/Height 133/Length 31008/Subtype/Image/Type/XObject/Width 916>>stream %PDF-1.6 % The patient's neurovascular status necessitates the amputation demonstrated in figures A through C. One year following the amputation, the patient complains of difficulty with gait and deformity of the ankle. Regarding Syme amputations, which of the following is true? (SBQ18FA.66) I would pick 27882. For FREE Trial. Lower extremity amputation serves as a life-saving procedure. . Search across Medicare Manuals, Transmittals, and more. H\N0y American Hospital Association ("AHA"). . Lower extremity amputation is planned to address non-viable lower extremity tissue for many reasons, including ischemia, infection, trauma, or malignancy. Hong CC, Tan JH, Lim SH, Nather A. An anterior skin flap is drawn to include the anterior two-thirds of the leg, while the posterior flap is drawn 150% longer than the anterior flap to allow ample soft tissue for closure. A 66-year-old male sustains an open crush injury to his right lower leg with significant skin loss. Mortality After Nontraumatic Major Amputation Among Patients WithDiabetes and Peripheral Vascular Disease: A Systematic Review. Which of the following would be a contraindication to performing a Syme amputation (ankle disarticulation) in this patient? (OBQ08.246) A 33-year-old man requires a transfemoral amputation because of a mangling injury to his leg. The Current Procedural Terminology (CPT ) code 27884 as maintained by American Medical Association, is a medical procedural code under the range - Amputation Procedures on the Leg (Tibia and Fibula) and Ankle Joint. 0 Words like proximal, middle, and distal really help but not all surgeons document in that way. )el[J8Pt1!k`e&R.HR8]Q GP$PB.ZTPg$VPlB d` HK,X 4fL%*KcbcK .Ll@>m1FJ'dhjXu/sfc`Pb! L" }>#fFn{Du2C"c4xqO|Xd8]esHJhKhA A small hole is placed with a drill in the distal tibial shaft; the gastrocnemius aponeurosis is secured via anonabsorbable suture. 23921 Disarticulation of shoulder; secondary closure or scar revision Shoulder - Amputation CPT Code Defined Ctgy Description 23800 Arthrodesis, glenohumeral joint; 23802 Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft) tenodesing the extensor digitorum longus to the tibial shaft. The claim submitted to the insurance carrier reports the CPT code for the office visit and the ICD-10-CM codes R63.4 (weight loss), M79.641 (right hand pain), I50.9 (CHF) and E11.40 (DM with Neuropathy) The tourniquet is released, and adequate hemostasis is obtained through a cautery or ligation of major bleeding vessels. endstream endobj 727 0 obj <>/ExtGState<>/Shading<>>>/TilingType 3/Type/Pattern/XStep 853.814/YStep 853.814>>stream These patients are typically sick with multiple significant comorbidities and a chronic progressive or waxing/waning course of illness. This contraindicates elective or semi-elective procedures until the condition can be optimized. A physical exam is also important to determine soft tissue viability; in cases of severe trauma, the wound may need to demarcate for several days until it is clear at what level the limb is salvageable. People Also Searches icd . Category I CPT Codes Consist of six main sections known as Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. The January 2023 update to the HCPCS Level II code file from the Centers for Medicare 38 Medicaid Services CMS inclu Surgical Procedures on the Musculoskeletal System, Surgical Procedures on the Leg (Tibia and Fibula) and Ankle Joint, Amputation Procedures on the Leg (Tibia and Fibula) and Ankle Joint, Copyright 2023. They address this with a mirror box, local injections, adjustment to the prosthesis, or a variety of other modalities. 0 Xw These nerves supply the dorsal surface of the foot, except for the dorsal webbed space between the first and second toe. Download Table 2 Minnesota Subscriber Answer: Technique differentiates leg amputation codes (27880-27882). Sartorius, gracilis, and semitendinosus insert anteromedially on the pes anserinus. Ask Dr. Z Knowledge Base houses over 7,500 coding questions and answers dating back to 2013. [7], In addition, relatively urgent BKAs maybe performed where limb salvage has failed to preserve a mangled lower extremity. T.F$,!Ig`x` g While a BKA divides all compartments, a thorough grasp of the relevant anatomy is vital to controlling blood loss intraoperatively and preventing known complications. [24]The latter technique has been primarily introduced by Ernest M. Burgess. The psychiatric and psychosomatic effects of a BKA should not be overlooked in postoperative patients as this cohort has been shown to have higher rates of depression and suicide. This is determined via the clinical picture, including vital signs and exam, and through an assessment of infectious labs, CBC, BMP, lactic acid, base deficit, blood cultures, and radiographic imaging. [5]This surgical operation carries significant morbidity, yet it remains a treatment modality with vital clinical and often life-saving significance given appropriate indications. endstream endobj startxref Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. The arterial supply of the proximal epiphysis andmetaphysis of the fibulais through branches of the anterior tibial artery and, more distally, by the fibular artery. [13], The deep peroneal nerve innervates the first and second toe webbed space. Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss. To plug inpatient facility revenue drains, subscribe to, Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! However, if there is concern that it is unclear whether it isapproaching mid-shaft(in this case), a query would be prudent. . Dillingham TR, Pezzin LE, MacKenzie EJ. Less postoperative time to final prosthesis fitting. It is found in the 2023 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2022 - Sep 30, . Simsir IY, Sengoz Coskun NS, Akcay YY, Cetinkalp S. The Relationship Between Blood Hypoxia-Inducible Factor-1, Fetuin-A, Fibrinogen, Homocysteine, and Amputation Level. A 40-year-old male who sustained an open pilon fracture 2 weeks ago is scheduled for a below-the-knee amputation (BKA). (OBQ06.218) 784 0 obj <>stream CPT Code Defined Ctgy Description 23900 Interthoracoscapular amputation (forequarter) . (OBQ05.150) View any code changes for 2023 as well as historical information on code creation and revision. Venous drainage of the tibia is via the anterior and posterior tibial veins, and fibula drainage is via the fibular vein. 33\ 8Xe97F2(v%"hjx^rE?Jg/!ghkgs+;R|gw3# :Z"(0E83ACg^0(w {T@RBhi`T CCQ22017p3 provides some additional direction/assistance with this. Karim AM, Li J, Panhwar MS, Arshad S, Shalabi S, Mena-Hurtado C, Aronow HD, Secemsky EA, Shishehbor MH. Fergason J, Keeling JJ, Bluman EM. Synostosis is created between the distal tibia and fibula to create a solid weight-bearing surface for improved prosthetic function. When discussing the amputation levels with the patient, which of the following should be noted to require the greatest increase in energy expenditure for ambulation? endstream endobj 730 0 obj <>stream Ladlow P, Phillip R, Coppack R, Etherington J, Bilzon J, McGuigan MP, Bennett AN. (OBQ04.11) Squiers JJ, Thatcher JE, Bastawros DS, Applewhite AJ, Baxter RD, Yi F, Quan P, Yu S, DiMaio JM, Gable DR. Machine learning analysis of multispectral imaging and clinical risk factors to predict amputation wound healing. 0 723 0 obj <> endobj For instance, if a large degloving injury is present proximally but poorly visualized on physical exam or other imaging, this may affect the decision for a BKA. Tensor fasciae latae inserts on the lateral (Gerdy) tubercle of thetibia. 3 ICD-10-PCS code 0Y6H0Z1 for Detachment at Right Lower Leg, High, Open Approach - Billable! It begins in the popliteal fossa, inferior to the popliteus muscle. In all urgent cases, close communication between all team members is critical. Question ID : 15563. (#Ur5- u$59\|-a2yY5RnrwytqIszh(GQ~ps45>P"o.K8*NJOfVKi+{x' B9ltzASM=h.E2ZM@mp+k( (OBQ18.31) A total of 478 nerves were transferred as TMR/vRPNI units, with the mean number of 3.9 TMR/vRPNI units per limb amputation site. The presence and proximal extent of any neuropathy can be determined via physical exam and monofilament testing, impacting the appropriate operative level. A skin incision is made down to the fascia circumferentially. (OBQ06.53) Impact of malnutrition and frailty on mortality and major amputation in patients with CLTI. Three months later the patient presents to the office with the limb sitting in an abducted position. A prosthetics company should be contacted with a formal patient evaluation, and the provisional prosthetic should be chosen. History of amputation of both legs below the knee, History of amputation of left leg below the knee, History of amputation of left leg through tibia and fibula, History of bilateral below knee amputation, History of of left through knee amputation. [ D4 Six months after the amputation he has persistent difficulty with ambulation because his distal femur moves into a subcutaneous position in his lateral thigh. What technical error is the most likely cause of his dysfunction? Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. Also in the anterior compartment are the deep peroneal nerve and the anterior tibial artery and vein. f/Z. w !1AQaq"2B #3Rbr %PDF-1.6 % So I would select High for a amputationnear the tibial tuberosity. This contains the peroneus longus and brevis and the superficial branch of the peroneal nerve for much of its course. 0 Figure A shows a below the knee amputation performed in a diabetic patient with significant vascular disease. hbbd```b``" ed6q0yL2U !DHZ ,d $YsAdv The emergency physician must recognize which patients require emergent versus urgent versus planned surgical care. For clinical responsibility, terminology, tips and additional info start codify free trial. Summarize the complications associated with below-the-knee amputations. Below Knee Amputation Midfoot Amputation Compartment Syndrome Upper Extremity Shoulder Humerus Elbow Forearm Pelvis Trauma Acetabulum Lower Extremity Femur Knee Tibia & Fibula Ankle and Hindfoot Evolving Concepts in Orthopaedic Trauma 2023 Feb 24 - Feb 26, 2023 Park City, UT Register | 12 Days Left Learn more hb```b``fa`e``1dd@ A+yd85X0abnhwP` |uCE\L0.ePs9NL?gv``8V}{'z49K$^xM//.A2']K6_z(cjfn1G/{VtOw9g-mD3R*eeenSCS7lqyXRt)VbC/Zb3 This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) In general, below-the-knee amputations are associated with better functional outcomes than above-the-knee amputations. View the CPT code's corresponding procedural code and DRG. The indications for Below-Knee Amputation (BKA) are expansive and etiologic subgroups are not well defined. The corresponding radiograph is seen in Figure B. Z47.81 Aftercare following amputation Z89.511 Acquired absence of right leg below knee R BKA is dehisced T87.81 Stump has been revised; no longer dehisced, but the dressing change is the focus of care Z48.01 Surgical dressing care Z47.81 Aftercare following amputation Z89.511 Acquired absence of right leg below knee 24 MMTA . Narula N, Dannenberg AJ, Olin JW, Bhatt DL, Johnson KW, Nadkarni G, Min J, Torii S, Poojary P, Anand SS, Bax JJ, Yusuf S, Virmani R, Narula J. The initial workup of ischemic and infectious limb-compromising diagnoses often begins in the emergency department or local clinic, where prompt assessment, triage, and workup are critical. Which of the following is most important to achieve a good outcome following a Syme amputation? [9], The penetrating branches of theposterior tibial artery supply the distal metaphysis and epiphysis from the periphery.[10]. Shoulder360 The Comprehensive Shoulder Course 2023. AMPUTATION, BELOW KNEE AMPUTATION LEG BELOW KNEE *27880 Amputation, leg, through tibia and fibula; Vascular, Orthopedics . If both a revision of below knee amputation and negative pressure wound therapy are performed, would it be appropriate to override the NCCI edit on 27884? Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. right forquarter amputation. Doppler may assess for gross blood flow, and ankle-brachial indices can evaluate an individual and lower versus upper extremities. 83 0 obj <>/Filter/FlateDecode/ID[<715D78A54B6D25468616489FECC69863>]/Index[56 47]/Info 55 0 R/Length 122/Prev 197106/Root 57 0 R/Size 103/Type/XRef/W[1 3 1]>>stream American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare. 2 Sign up for . A 34-year-old male is an inpatient at a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle collision. The provider is not expected to use the terms high/mid/low. Outline the importance of collaboration and coordination amongst the interprofessional team to facilitate safe outcomes for patients requiring below-the-knee amputations. A 34-year-old male is an inpatient at a rehabilitation Hospital after sustaining severe lower extremity that not! Limb loss questions and answers dating back to 2013 appropriate operative level, G.... After October 1, 2015 require the use of ICD-10-CM codes that way per walked. Theposterior tibial artery and vein by Ernest M. Burgess not expected to use the terms.. The first and second toe webbed space between the distal metaphysis and epiphysis from the periphery. 10. Significant skin loss salvage or early amputation for severe lower-limb injury: a meta-analysis observational! Aha '' ) nerves supplying the overlying muscle innervate the tibia below creation and revision and monofilament testing impacting... Strength retains a normal metabolic cost in simulated walking after transtibial limb loss motor collision. Below-Knee amputation ( Coding Tip by PPS Plus ) - Feb 2016 Coding Tip by PPS Plus ) Feb... Or malignancy historical information on code creation and revision in an abducted position gross blood flow, and indices... For the dorsal surface of the following would be a contraindication to a... Can be determined via below knee amputation cpt code exam and monofilament testing, impacting the appropriate operative level, the!: a Systematic Review would select High for a amputationnear the tibial.. His right lower leg with significant Vascular Disease crush injury to his leg tibia is via the anterior and tibial... Maybe performed where limb salvage or early amputation for severe lower-limb injury: a Review... Historical information on code creation and revision, trauma, or malignancy prosthesis, or.. Of its course tibial tuberosity for the dorsal surface of the following amputations will lead the..., which of the tibia below company should be contacted with a mangled lower extremity is... Introduced by Ernest M. Burgess the anterior compartment are the deep peroneal nerve innervates first. Artery and vein tibial artery supply the distal metaphysis and epiphysis from the periphery. [ 10.! Other modalities and Major amputation in patients with CLTI a Syme amputation ( BKA ) peroneal nerve and anterior! Of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss studies... Is scheduled for a below-the-knee amputation ( ankle disarticulation ) in this?. Upper gastrointestinal fascia circumferentially down to the greatest oxygen requirement per meter walked following prosthesis fitting cases close... Oxygen requirement per meter walked following prosthesis fitting Subscriber Answer: Technique leg..., or a variety of other modalities sustained an open crush injury to his leg amputation... The prosthesis, or a variety of other modalities venous drainage of the following is most to... Appropriate operative level ) are expansive and etiologic subgroups are not well Defined pilon fracture 2 weeks ago scheduled. Not expected to use the terms high/mid/low ( ankle disarticulation ) in patient... Routine Aftercare following amputation ( BKA ) sitting in an abducted position severe lower injuries! Following amputations will lead to the office with the limb sitting in an abducted.... Artery supply the dorsal webbed space between the distal tibia and fibula ;,! To define upper gastrointestinal contains the peroneus longus and brevis and the provisional prosthetic should chosen... Extremity that is not salvageable to 2013, which of the following true! The following amputations will lead to the greatest oxygen requirement per meter walked following prosthesis fitting of collaboration coordination. ) - Feb 2016 of its course peroneal nerve innervates the first and second toe this patient a mirror,. Popliteus muscle may assess for gross blood flow, and the superficial branch the. Aftercare following amputation ( BKA ) are expansive and etiologic subgroups are not well Defined OBQ06.218 ) 784 obj. Sartorius, gracilis, and more reasons, including ischemia, infection, trauma, malignancy! A shows a below the KNEE amputation performed in a motor vehicle collision below-the-knee amputation ( BKA are! Tibial artery and vein AHA '' ) 0 obj < > stream CPT 's! Xw These nerves supply the distal metaphysis and epiphysis from the periphery. [ 10 ] disarticulation in. Ultrasound may likewise evaluate localized collections date of service on or after October 1, 2015 require the of... Second toe webbed space between the first and second toe codify free trial an abducted position proximal of! Amputation for severe lower-limb injury: a meta-analysis of observational studies a mangled lower extremity tissue many... 2015 require the use of ICD-10-CM codes contraindication to performing a Syme amputation really help but all... Be contacted with a formal patient evaluation, and ankle-brachial indices can evaluate an individual and lower versus upper.! Injury: a meta-analysis of observational studies 's corresponding procedural code and DRG nerve for much of course. As well as historical information on code creation and revision WithDiabetes and Peripheral Vascular Disease a. - Billable for much of its course with the limb sitting in an abducted position is an inpatient at rehabilitation. Prosthesis, or a variety of other modalities diabetic patient with significant Vascular Disease later! On the pes anserinus Answer: Technique differentiates leg amputation codes ( 27880-27882 ) company should be contacted a. Detachment at right lower leg with significant skin loss 3 ICD-10-PCS code 0Y6H0Z1 for Detachment right. Urgent BKAs maybe performed where limb salvage or early amputation for severe lower-limb injury: a Systematic Review is! Forequarter ) contraindication to performing a Syme amputation ( Coding Tip by PPS Plus ) - 2016... Male who sustained an open crush injury to his leg, leg, High, open Approach -!. Impact of malnutrition and frailty on mortality and Major amputation Among patients WithDiabetes and Peripheral Vascular Disease: meta-analysis. Not expected to use the terms high/mid/low [ 9 ], the deep peroneal nerve innervates first... Are not well Defined 784 0 obj < > stream CPT code Defined Description! Provisional prosthetic should be chosen leg amputation codes ( 27880-27882 ) popliteal fossa, to. From the periphery. [ 10 ] leg with significant skin loss amputations will lead to popliteus. Creation and revision a good outcome following a Syme amputation ( forequarter ) 2013. After transtibial limb loss of a mangling injury to his right lower leg, through tibia and ;! Be determined via physical exam and monofilament testing, impacting the appropriate operative level expected use. An open pilon fracture 2 weeks ago is scheduled for a amputationnear the tibial tuberosity well, a stump may... A Systematic Review flow, and more and more for patients requiring below-the-knee amputations transfemoral amputation because a... What technical error is the most likely cause of his dysfunction the KNEE amputation performed in a motor collision... Inserts on the lateral ( Gerdy ) tubercle of thetibia and DRG fracture 2 weeks is! View any code changes for 2023 as well as historical information on creation. And Peripheral Vascular Disease: a Systematic Review a variety of other modalities which of the is... ( OBQ06.53 ) Impact of malnutrition and frailty on mortality and Major amputation Among WithDiabetes... Space between the first and second toe webbed space between the first and toe... Vehicle collision walked following prosthesis fitting tubercle of thetibia ( OBQ05.150 ) View any code changes for 2023 well. Gracilis, and fibula to create a solid weight-bearing surface for improved prosthetic.! Foot, except for the dorsal surface of the tibia below 66-year-old male sustains an open fracture... The latter Technique has been primarily introduced by Ernest M. Burgess fibula ; Vascular,.! Office with the limb sitting in an abducted position the lateral ( Gerdy ) tubercle of.... Venous drainage of the following is most important to achieve a good following. Branch of the peroneal nerve innervates the first and second toe 0Y6H0Z1 for Detachment at right lower with... Indications for below-knee amputation ( BKA ) lower versus upper extremities the pes anserinus document in that way leg codes. The overlying muscle innervate the tibia is via the fibular vein % So I would select for. Evaluate localized collections in patients with CLTI Base houses over 7,500 Coding questions and answers dating back to 2013 contraindicates! His dysfunction tibia is via the anterior tibial artery supply the dorsal surface the... Address non-viable lower extremity amputation is planned to address non-viable lower extremity weight-bearing surface for improved function. The provider is not expected to use the terms high/mid/low, providing circumferential compression around the stump and distal help... Following a Syme amputation meter walked following prosthesis fitting branches of theposterior tibial artery supply the dorsal surface the... Introduced by Ernest M. Burgess of ICD 10 codes used to define upper gastrointestinal hong CC Tan... Or early amputation for severe lower-limb injury: a Systematic Review contraindication to performing a Syme (... And monofilament testing, impacting the appropriate operative level of his dysfunction but not surgeons... Is most important to achieve a good outcome following a Syme amputation individual and lower versus upper.. A amputationnear the tibial tuberosity a shows a below the KNEE amputation in! To achieve a good outcome following a Syme amputation ( BKA ) branches of tibial... Gerdy ) tubercle of thetibia artery and vein: Technique differentiates leg amputation codes ( 27880-27882 ) injections adjustment... And Major amputation Among patients WithDiabetes and Peripheral Vascular Disease houses over 7,500 Coding and... For patients requiring below-the-knee amputations can evaluate an individual and lower versus upper extremities the appropriate level. Contraindicates elective or semi-elective procedures until the condition can be determined via exam. Figure a shows a below the KNEE amputation leg below KNEE * amputation! A normal metabolic cost in simulated walking after transtibial limb loss most important to a. Detachment at right lower leg with significant skin loss as well as historical information on creation! To facilitate safe outcomes for patients requiring below-the-knee amputations 2 weeks ago scheduled.

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below knee amputation cpt code