Summary & Overview
CPT 27888: Ankle-Level Transtibial (Foot) Amputation
CPT code 27888 denotes an ankle-level surgical amputation that removes the foot across the distal tibia/fibula knobs to manage nonhealing wounds caused by infection or ischemia. The procedure includes nerve excision and soft-tissue reconstruction to create a functional stump capable of weight-bearing. This code is clinically significant as rates of limb-threatening infection and peripheral vascular disease contribute to demand for lower-extremity amputation nationally, and appropriate coding affects inpatient and outpatient surgical billing and quality measurement.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, how the service is documented for claims, and what to expect in terms of typical sites of service. The publication also summarizes benchmarking elements and relevant policy considerations that commonly affect coverage and payment for major lower-extremity amputations. The content is intended to support coding accuracy, administrative workflows, and payer engagement without providing clinical directives.
Billing Code Overview
CPT code 27888 describes a surgical transtibial amputation performed through the ankle region, where the provider amputates the foot across the bone knobs on either side of the ankle to treat nonhealing wounds from infection or poor circulation. The procedure includes excision of nerves and reconstruction of skin and soft tissues to create a functional, weight-bearing stump.
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Service type: Surgical amputation of the distal lower extremity (ankle/foot level) with soft-tissue reconstruction
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Typical site of service: Hospital operating room or ambulatory surgical center with postoperative inpatient or outpatient recovery
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old with long-standing peripheral arterial disease and diabetes who presents with a nonhealing, infected forefoot ulcer with exposed bone despite wound care and antibiotic therapy. The foot has ischemic changes, recurrent infection, and pain that impairs ambulation. Vascular evaluation has been performed and either revascularization was not feasible or failed. The surgical team (orthopedic or vascular surgeon) schedules a transtibial-level-sparing partial foot amputation across the ankle bone knobs to remove infected tissue, excise nerves, and reconstruct skin and soft tissues to create a durable stump for weightbearing and prosthetic or shoe modification.
Preoperative workflow includes history and physical, review of vascular studies, infection control (cultures and targeted antibiotics), informed consent addressing limb salvage options, and anesthesia evaluation. Intraoperative steps include debridement of infected and necrotic tissue, bone resection across the malleoli, nerve handling, and layered soft-tissue closure or flap reconstruction as needed. Postoperative care involves pain control, wound monitoring, infection surveillance, vascular support, physical therapy for mobility and stump care, and coordination with prosthetics or shoe specialists when indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the amputation is performed on the left foot/ankle |