Complete vs Incomplete Amputation

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QUESTION:  Is this a PARTIAL or COMPLETE Amputation Code (S78.121A or S78.11)

Clinical Indicators:  Pt presents to ED following a motorcycle accident. Documentation states "Obvious traumatic injuries to bilateral legs with traumatic amputation of R leg with only posterior skin intact".

Operative Report states "Preoperative Dx:  Right partial above knee amputation.  ICD 10 code is S78.121A."

Operative Procedure states "Amputation of right thigh above the knee.  CPT code is 27592."

Op Report further states:

The right lower extremity was segmentally fractured in the region of the supracondylar femur as well as the shaft in addition to a segmental tibial shaft fracture.  There were no pulses to the right lower extremity.  This appeared to be a nonsalvageable limb.

Approximately 3 cm proximal to the most proximal fracture line, we then transected the femur with an oscillating saw.  We began the process of debridement of the soft tissues, which included quadriceps musculature as well as neurovascular structures.  We identified the profunda femoral artery and ligated this with 2-0 silk suture ligature.  We then transected this with a Metzenbaum scissors and circumferentially dissected about the thigh in the region of the mid shaft.  Once we had removed the leg, we then began the meticulous process of debriding the muscle.  Muscle in this region appeared nonviable as there was a vascular injury to the right lower extremity.  We utilized sharp excisional debridement technique to debride the muscle with a 10 blade scalpel and pickups as well as Bovie electrocautery.  Following thorough debridement, we then irrigated copiously with 3000 mL of normal saline in a low-pressure pulsatile fashion.  We then curettaged the intramedullary canal of the residual femur and irrigated the right lower extremity yet again with 3000 mL of normal saline in a low-pressure pulsatile fashion.  Upon completion, the wound appeared markedly cleaner.  We then preserved a large posterolateral soft tissue flap and this was irrigated along with the remainder of the right lower extremity with 3000 mL of normal saline in a low-pressure pulsatile fashion.  Once we had completed this, we then applied KCI wound VAC to the right lower extremity.  This wound measured approximately 40 cm x 30 cm.  Following completion of the wound VAC application, which was held in place with the KCI wound VAC tape and 3M Ioban tape.  We attached to the suction device and achieved 150 mmHg suction seal. "

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