| 84.1 |
09 |
Amputation of lower limb |
NA |
Y |
Y |
| 84.10 |
09 |
Lower limb amputation, not otherwise specified |
NA |
Y |
Y |
| 84.11 |
09 |
Amputation of toe |
NA |
Y |
Y |
| 84.12 |
09 |
Amputation through foot |
NA |
Y |
Y |
| 84.13 |
09 |
Disarticulation of ankle |
NA |
Y |
Y |
| 84.14 |
09 |
Amputation of ankle through malleoli of tibia and fibula |
NA |
Y |
Y |
| 84.15 |
09 |
Other amputation below knee |
NA |
Y |
Y |
| 84.16 |
09 |
Disarticulation of knee |
NA |
Y |
Y |
| 84.17 |
09 |
Amputation above knee |
NA |
Y |
Y |
| 27880 |
C4 |
Amputation, leg, through tibia and fibula |
NA |
Y |
Y |
| 27882 |
C4 |
Amputation, leg, through tibia and fibula; open, circular |
NA |
Y |
Y |
| 27884 |
C4 |
Amputation, leg, through tibia and fibula; secondary closure or scar revision |
NA |
Y |
Y |
| 27886 |
C4 |
Amputation, leg, through tibia and fibula; re-amputation |
NA |
Y |
Y |
| 27889 |
C4 |
Ankle disarticulation |
NA |
Y |
Y |
| 27590 |
C4 |
Amputation, thigh, through femur,any level |
NA |
Y |
Y |
| 27594 |
C4 |
Amputation, thigh, through femur, any level; secondary closure or scar revision |
NA |
Y |
Y |
| 27596 |
C4 |
Amputation, thigh, through femur, any level; re-amputation; (-RT Right side of body) |
NA |
Y |
Y |
| 27598 |
C4 |
Disarticulation at knee |
NA |
Y |
Y |
| 27591 |
C4 |
Amputation, Thigh, Through Femur, Any Level; Immediate Fitting Technique Including First Cast |
NA |
Y |
Y |
| 27592 |
C4 |
Amputation, Thigh, Through Femur, Any Level; Open, Circular (Guillotine) |
NA |
Y |
Y |
| 27881 |
C4 |
Amputation, Leg, Through Tibia And Fibula; With Immediate Fitting Technique Including Application Of First Cast |
NA |
Y |
Y |
| 27888 |
C4 |
Amputation, Ankle, Through Malleoli Of Tibia And Fibula (Eg, Syme, Pirogoff Type Procedures), With Plastic Closure And Resection Of Nerves |
NA |
Y |
Y |
| 28800 |
C4 |
Amputation, Foot; Midtarsal (Eg, Chopart Type Procedure) |
NA |
Y |
Y |
| 28805 |
C4 |
Amputation, Foot; Transmetatarsal |
NA |
Y |
Y |
| 28810 |
C4 |
Amputation, Metatarsal, With Toe, Single |
NA |
Y |
Y |
| 28820 |
C4 |
Amputation, Toe; Metatarsophalangeal Joint |
NA |
Y |
Y |
| 28825 |
C4 |
Amputation, Toe; Interphalangeal Joint |
NA |
Y |
Y |
| 106765 |
LO |
Toe Amputation |
KPNC |
Y |
Y |
| 106766 |
LO |
Foot Amputation |
KPNC |
Y |
Y |
| 106768 |
LO |
Leg Amputation Above Knee |
KPNC |
Y |
Y |
| 129261 |
LO |
Amputation Stump Revision |
KPNC |
Y |
Y |
| 161928 |
LO |
Foot Amputation Symes Type |
KPNC |
Y |
Y |
| 166812 |
LO |
Leg Amputation Below Knee |
KPNC |
Y |
Y |
| 170273 |
LO |
Lesser Toe Amputation, 2nd Toe |
KPNC |
Y |
Y |
| 170274 |
LO |
Lesser Toe Amputation, 3rd Toe |
KPNC |
Y |
Y |
| 170275 |
LO |
Lesser Toe Amputation, 4thtoe |
KPNC |
Y |
Y |
| 170276 |
LO |
Lesser Toe Amputation, 5th Toe |
KPNC |
Y |
Y |
| 170299 |
LO |
First Ray Amputation, Hallux, Complete Or Partial |
KPNC |
Y |
Y |
| 170300 |
LO |
First Ray Amputation, First Ray, Complete Or Partial |
KPNC |
Y |
Y |
| 170315 |
LO |
Lesser Metatarsal Amputation, Lesser Ray, Complete |
KPNC |
Y |
Y |
| 170316 |
LO |
Lesser Metatarsal Amputation, Lesser Ray, Partial |
KPNC |
Y |
Y |
| 170323 |
LO |
Midfoot Amputation |
KPNC |
Y |
Y |
| 192281 |
LO |
Foot Amputation Transmetatarsal |
KPNC |
Y |
Y |
| 192595 |
LO |
Foot Amputation Revision |
KPNC |
Y |
Y |
| B1001 |
LO |
B1001amputation, Lower Extremity With Motor >47.65.,Comorbidity In Tier 1 |
KPNC |
Y |
Y |
| 220023 |
LO |
AMPUTATION OF LEG BELOW KNEE |
KPHI |
Y |
Y |
| 220027 |
LO |
AMPUTATION OF TOE |
KPHI |
Y |
Y |
| 221069 |
LO |
REVISION OF AMPUTATION STUMP |
KPHI |
Y |
Y |
| 223081 |
LO |
AMPUTATION, HALLUX, COMPLETE OR PARTIAL, FIRST RAY |
KPHI |
Y |
Y |
| 223082 |
LO |
AMPUTATION, COMPLETE OR PARTIAL, FIRST RAY |
KPHI |
Y |
Y |
| 223083 |
LO |
AMPUTATION FOOT |
KPHI |
Y |
Y |
| 226239 |
LO |
LEG AMPUTATION ABOVE KNEE |
KPHI |
Y |
Y |
| 226260 |
LO |
FOOT AMPUTATION TRANSMETATARSAL |
KPHI |
Y |
Y |
| 0Y6C0Z1 |
10 |
Detachment at Right Upper Leg, High, Open Approach |
NA |
Y |
Y |
| 0Y6C0Z2 |
10 |
Detachment at Right Upper Leg, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6C0Z3 |
10 |
Detachment at Right Upper Leg, Low, Open Approach |
NA |
Y |
Y |
| 0Y6D0Z1 |
10 |
Detachment at Left Upper Leg, High, Open Approach |
NA |
Y |
Y |
| 0Y6D0Z2 |
10 |
Detachment at Left Upper Leg, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6D0Z3 |
10 |
Detachment at Left Upper Leg, Low, Open Approach |
NA |
Y |
Y |
| 0Y6F0ZZ |
10 |
Detachment at Right Knee Region, Open Approach |
NA |
Y |
Y |
| 0Y6G0ZZ |
10 |
Detachment at Left Knee Region, Open Approach |
NA |
Y |
Y |
| 0Y6H0Z1 |
10 |
Detachment at Right Lower Leg, High, Open Approach |
NA |
Y |
Y |
| 0Y6H0Z2 |
10 |
Detachment at Right Lower Leg, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6H0Z3 |
10 |
Detachment at Right Lower Leg, Low, Open Approach |
NA |
Y |
Y |
| 0Y6J0Z1 |
10 |
Detachment at Left Lower Leg, High, Open Approach |
NA |
Y |
Y |
| 0Y6J0Z2 |
10 |
Detachment at Left Lower Leg, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6J0Z3 |
10 |
Detachment at Left Lower Leg, Low, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z0 |
10 |
Detachment at Right Foot, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z4 |
10 |
Detachment at Right Foot, Complete 1st Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z5 |
10 |
Detachment at Right Foot, Complete 2nd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z6 |
10 |
Detachment at Right Foot, Complete 3rd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z7 |
10 |
Detachment at Right Foot, Complete 4th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z8 |
10 |
Detachment at Right Foot, Complete 5th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0Z9 |
10 |
Detachment at Right Foot, Partial 1st Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0ZB |
10 |
Detachment at Right Foot, Partial 2nd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0ZC |
10 |
Detachment at Right Foot, Partial 3rd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0ZD |
10 |
Detachment at Right Foot, Partial 4th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6M0ZF |
10 |
Detachment at Right Foot, Partial 5th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z0 |
10 |
Detachment at Left Foot, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z4 |
10 |
Detachment at Left Foot, Complete 1st Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z5 |
10 |
Detachment at Left Foot, Complete 2nd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z6 |
10 |
Detachment at Left Foot, Complete 3rd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z7 |
10 |
Detachment at Left Foot, Complete 4th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z8 |
10 |
Detachment at Left Foot, Complete 5th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0Z9 |
10 |
Detachment at Left Foot, Partial 1st Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0ZB |
10 |
Detachment at Left Foot, Partial 2nd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0ZC |
10 |
Detachment at Left Foot, Partial 3rd Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0ZD |
10 |
Detachment at Left Foot, Partial 4th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6N0ZF |
10 |
Detachment at Left Foot, Partial 5th Ray, Open Approach |
NA |
Y |
Y |
| 0Y6P0Z0 |
10 |
Detachment at Right 1st Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6P0Z1 |
10 |
Detachment at Right 1st Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6P0Z2 |
10 |
Detachment at Right 1st Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6P0Z3 |
10 |
Detachment at Right 1st Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6Q0Z0 |
10 |
Detachment at Left 1st Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6Q0Z1 |
10 |
Detachment at Left 1st Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6Q0Z2 |
10 |
Detachment at Left 1st Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6Q0Z3 |
10 |
Detachment at Left 1st Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6R0Z0 |
10 |
Detachment at Right 2nd Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6R0Z1 |
10 |
Detachment at Right 2nd Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6R0Z2 |
10 |
Detachment at Right 2nd Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6R0Z3 |
10 |
Detachment at Right 2nd Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6S0Z0 |
10 |
Detachment at Left 2nd Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6S0Z1 |
10 |
Detachment at Left 2nd Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6S0Z2 |
10 |
Detachment at Left 2nd Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6S0Z3 |
10 |
Detachment at Left 2nd Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6T0Z0 |
10 |
Detachment at Right 3rd Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6T0Z1 |
10 |
Detachment at Right 3rd Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6T0Z2 |
10 |
Detachment at Right 3rd Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6T0Z3 |
10 |
Detachment at Right 3rd Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6U0Z0 |
10 |
Detachment at Left 3rd Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6U0Z1 |
10 |
Detachment at Left 3rd Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6U0Z2 |
10 |
Detachment at Left 3rd Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6U0Z3 |
10 |
Detachment at Left 3rd Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6V0Z0 |
10 |
Detachment at Right 4th Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6V0Z1 |
10 |
Detachment at Right 4th Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6V0Z2 |
10 |
Detachment at Right 4th Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6V0Z3 |
10 |
Detachment at Right 4th Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6W0Z0 |
10 |
Detachment at Left 4th Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6W0Z1 |
10 |
Detachment at Left 4th Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6W0Z2 |
10 |
Detachment at Left 4th Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6W0Z3 |
10 |
Detachment at Left 4th Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6X0Z0 |
10 |
Detachment at Right 5th Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6X0Z1 |
10 |
Detachment at Right 5th Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6X0Z2 |
10 |
Detachment at Right 5th Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6X0Z3 |
10 |
Detachment at Right 5th Toe, Low, Open Approach |
NA |
Y |
Y |
| 0Y6Y0Z0 |
10 |
Detachment at Left 5th Toe, Complete, Open Approach |
NA |
Y |
Y |
| 0Y6Y0Z1 |
10 |
Detachment at Left 5th Toe, High, Open Approach |
NA |
Y |
Y |
| 0Y6Y0Z2 |
10 |
Detachment at Left 5th Toe, Mid, Open Approach |
NA |
Y |
Y |
| 0Y6Y0Z3 |
10 |
Detachment at Left 5th Toe, Low, Open Approach |
NA |
Y |
Y |