How To Use CPT Code 26055

CPT 26055 describes the procedure of tendon sheath incision, specifically for conditions like trigger finger. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26055?

CPT 26055 is a code used to describe the procedure of tendon sheath incision, specifically for conditions like trigger finger. Trigger finger, also known as stenosing tenosynovitis, is a condition where a finger remains in a bent position and is painful to open or close. It can be caused by a swollen tendon, formation of knots or nodules in the tendon, trauma, or medical conditions like rheumatoid arthritis.

2. Official Description

The official description of CPT code 26055 is: ‘Tendon sheath incision (e.g., for trigger finger).’ This code is used when a healthcare provider makes a small incision in the skin above the tendon sheath and dissects down into the sheath causing the restriction. The provider then releases the tight portion of the flexor tendon that is causing the obstruction and sutures the wound closed in layers.

3. Procedure

1. While the patient is prepped and anesthetized, the healthcare provider makes a small incision (about 2 cm) in the skin above the tendon sheath.
2. The provider then dissects down into the sheath that is causing the restriction.
3. Next, the provider releases the tight portion of the flexor tendon that is causing the obstruction.
4. The wound is then sutured closed in layers.
5. Finally, a sterile bandage is applied to the incision site.

4. Qualifying circumstances

CPT 26055 is used for patients with conditions like trigger finger, where a tendon sheath incision is necessary to relieve the restriction caused by a swollen tendon or formation of knots or nodules. The procedure is typically performed by a healthcare provider who has determined that the patient’s symptoms and condition warrant the intervention.

5. When to use CPT code 26055

CPT code 26055 should be used when a healthcare provider performs a tendon sheath incision for conditions like trigger finger. It is important to ensure that the procedure is medically necessary and appropriate for the patient’s condition. Other treatment options should be considered and exhausted before resorting to a tendon sheath incision.

6. Documentation requirements

To support a claim for CPT 26055, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for a tendon sheath incision
• Date of the procedure
• Details of the procedure, including the location and size of the incision
• Any complications or additional procedures performed
• Post-procedure instructions and follow-up plans
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 26055, ensure that the procedure meets the criteria for medical necessity and appropriate usage. It is important to accurately document and code the procedure to avoid any billing errors or denials. CPT code 26055 should not be reported with other codes unless additional procedures were performed during the same session.

8. Historical information

CPT 26055 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs a tendon sheath incision on a patient with trigger finger, relieving the restriction and improving finger movement.
2. A patient with a swollen tendon in their finger undergoes a tendon sheath incision, allowing for pain-free finger movement.
3. A healthcare provider performs a tendon sheath incision on a patient with trigger finger caused by rheumatoid arthritis, improving their ability to use their hand.
4. A patient with a knot or nodule in their finger tendon undergoes a tendon sheath incision, resolving the restriction and restoring finger function.
5. A healthcare provider performs a tendon sheath incision on a patient with a traumatic trigger finger, alleviating their pain and improving finger mobility.
6. A patient with a trigger finger undergoes a tendon sheath incision, allowing them to resume their daily activities without discomfort.
7. A healthcare provider performs a tendon sheath incision on a patient with a chronic trigger finger, providing long-term relief and improved finger function.
8. A patient with a trigger finger caused by repetitive hand movements undergoes a tendon sheath incision, allowing them to continue their work without pain.
9. A healthcare provider performs a tendon sheath incision on a patient with a severe trigger finger, restoring their ability to fully extend and flex their finger.
10. A patient with a trigger finger that did not respond to conservative treatments undergoes a tendon sheath incision, providing them with relief and improved finger mobility.