Procedure date: 01/12/20XX. Surgeon: MD. Assistant: PA. Preoperative diagnosis: Dry gangrene of the left foot in the setting of peripheral vascular disease. Non-pressure chronic ulcer on toe. Postoperative diagnosis: Dry gangrene of the left foot in the setting of peripheral vascular disease. Non-pressure chronic ulcer on toe. Procedure: Amputation at the metatarsophalangeal joint of the left third toe. Indication: 63-
year-old female with peripheral vascular disease; vascular workup determined no further interventions to
improve vascularity; third toe became progressively dusky; wound formed distally with chronic ulcer;
amputation necessary; risks/benefits discussed. Description: Left foot and third toe marked; 1 g Ancef
given; general anesthesia; supine; calf tourniquet; timeout; tourniquet inflated, no Esmarch; total tourniquet
time 5 minutes; tennis racquet incision with longitudinal arm over third metatarsal encircling joint proximal
to closure; extensor/flexor tendons and collateral ligaments excised sharply; toe removed; tourniquet
released; superficial bleeders cauterized; washed out; skin closed with 3-0 nylon; dry dressing; to PACU in
good condition; signed 01/19/20XX 09:41.
What CPT(R) and ICD-10-CM coding is reported?