How To Use CPT Code 26160

CPT 26160 refers to the excision of a lesion from a tendon sheath or joint capsule in the hand or finger. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 26160 procedures.

1. What is CPT 26160?

CPT 26160 is a medical procedure code used to describe the excision of a lesion, such as a cyst or ganglion, from a tendon sheath or joint capsule in the hand or finger. This code is utilized by healthcare providers to accurately document and bill for this specific surgical procedure.

2. 26160 CPT code description

The official description of CPT code 26160 is: “Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger.”

3. Procedure

The 26160 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the skin over the affected tendon or joint in the hand or finger.
3. Dissection is performed through the subcutaneous tissue to expose the tendon sheath or joint capsule.
4. Nerves and blood vessels in the area are retracted for safety.
5. The lesion in the tendon sheath or joint capsule is identified.
6. The lesion is excised from its base.
7. Hemostasis is obtained at the surgical site.
8. The wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 26160 services are those who have a lesion, such as a cyst or ganglion, within the tendon sheath or joint capsule of the hand or finger. The lesion must be causing pain, discomfort, or functional impairment, and conservative treatment options must have been exhausted or deemed inappropriate for the patient’s condition.

5. When to use CPT code 26160

It is appropriate to bill the 26160 CPT code when the provider performs the excision of a lesion from a tendon sheath or joint capsule in the hand or finger, as described in the procedure section. This code should be used when the patient meets the qualifying circumstances and the procedure is deemed medically necessary by the healthcare provider.

6. Documentation requirements

To support a claim for CPT 26160, the following information should be documented in the patient’s medical record:

• Patient’s medical history and physical examination findings
• Diagnosis of the lesion in the tendon sheath or joint capsule
• Conservative treatment options attempted or considered
• Rationale for the surgical intervention
• Details of the surgical procedure, including anesthesia, incision, dissection, lesion excision, and wound closure
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 26160, it is essential to follow the specific guidelines and rules set forth by the payer. Some tips for billing this code include:

• Ensure that the patient meets the qualifying circumstances for the procedure.
• Document the medical necessity of the procedure in the patient’s medical record.
• Verify the payer’s specific requirements for billing CPT 26160, as they may vary between payers.
• Be aware of any additional codes that may apply to the procedure, such as anesthesia or facility fees.

8. Historical information

CPT 26160 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2002, with the previous descriptor being “Excision of lesion of tendon sheath or capsule (eg, cyst, mucous cyst, or ganglion), hand or finger.”

9. Similar codes to CPT 26160

Five similar codes to CPT 26160 and how they differentiate are:

1. CPT 25111: This code refers to the excision of a wrist ganglion, which is different from the hand or finger location in CPT 26160.
2. CPT 25112: This code is for the excision of a wrist ganglion with the involvement of the carpal joint, also different from the hand or finger location in CPT 26160.
3. CPT 26055: This code is used for the release of a trigger digit, which is a different procedure than the excision of a lesion in CPT 26160.
4. CPT 26145: This code involves the excision of a palmar fascial lesion, which is a different anatomical location and type of lesion than CPT 26160.
5. CPT 26170: This code is for the excision of a lesion in the pulp of a finger, which is a different anatomical location than the tendon sheath or joint capsule in CPT 26160.

10. Examples

Here are 10 detailed examples of CPT code 26160 procedures:

1. Excision of a ganglion cyst from the flexor tendon sheath of the index finger.
2. Removal of a mucous cyst from the metacarpophalangeal joint capsule of the thumb.
3. Excision of a synovial cyst from the extensor tendon sheath of the middle finger.
4. Removal of a ganglion cyst from the proximal interphalangeal joint capsule of the ring finger.
5. Excision of a mucous cyst from the distal interphalangeal joint capsule of the little finger.
6. Removal of a synovial cyst from the flexor tendon sheath of the thumb.
7. Excision of a ganglion cyst from the extensor tendon sheath of the index finger.
8. Removal of a mucous cyst from the metacarpophalangeal joint capsule of the middle finger.
9. Excision of a synovial cyst from the proximal interphalangeal joint capsule of the ring finger.
10. Removal of a ganglion cyst from the distal interphalangeal joint capsule of the little finger.