How To Use CPT Code 26100

CPT 26100 describes a specific procedure involving the carpometacarpal joint in the wrist. 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 26100?

CPT 26100 is a code used to describe a procedure that involves making an incision to open the carpometacarpal joint in the wrist and taking a biopsy of the soft tissue. This procedure allows the healthcare provider to examine the joint and collect tissue samples for further analysis.

2. Official Description

The official description of CPT code 26100 is: ‘Arthrotomy with biopsy; carpometacarpal joint, each.’

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia.
2. An incision is made in the skin above the carpometacarpal joint.
3. The provider dissects through the subcutaneous tissue to reach the joint capsule.
4. The joint capsule is incised and opened.
5. The provider explores the joint space to identify any abnormalities.
6. A biopsy of the joint tissue, such as synovial tissue, is taken for analysis.
7. The wound is irrigated with antibiotic solution.
8. The wound is closed in layers, and a drain may be left in place if necessary.

4. Qualifying circumstances

CPT 26100 is used when a healthcare provider performs an arthrotomy with biopsy on the carpometacarpal joint. This procedure is typically done to investigate and diagnose conditions affecting the joint, such as arthritis or other inflammatory disorders. It is important to note that this code is specific to the carpometacarpal joint and should not be used for other joints.

5. When to use CPT code 26100

CPT code 26100 should be used when a healthcare provider performs an arthrotomy with biopsy on the carpometacarpal joint. It is important to ensure that the procedure is performed on the correct joint and that the biopsy is taken for analysis. This code should not be used for procedures involving other joints.

6. Documentation requirements

To support a claim for CPT 26100, the healthcare provider must document the following information:

• Patient’s diagnosis or reason for performing the procedure
• Details of the procedure, including the incision, exploration of the joint, and biopsy
• Any abnormalities or findings during the procedure
• Use of anesthesia and any complications
• Post-procedure care, including wound irrigation and closure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 26100, ensure that the procedure is performed on the carpometacarpal joint. It is important to accurately document the details of the procedure and any associated findings. This code should not be reported with other codes unless there are separate and distinct procedures performed on different joints. It is important to follow the specific guidelines provided by the payer and ensure accurate coding and documentation.

8. Historical information

CPT 26100 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 an arthrotomy with biopsy on the carpometacarpal joint of a patient with suspected arthritis.
2. During a surgical procedure, a surgeon opens the carpometacarpal joint and takes a biopsy of the soft tissue for further analysis.
3. A patient with chronic wrist pain undergoes an arthrotomy with biopsy on the carpometacarpal joint to determine the cause of their symptoms.
4. A healthcare provider performs an arthrotomy with biopsy on the carpometacarpal joint of a patient with a history of joint inflammation.
5. During a diagnostic procedure, a surgeon opens the carpometacarpal joint and collects tissue samples for analysis.
6. A patient with limited mobility in their wrist undergoes an arthrotomy with biopsy on the carpometacarpal joint to assess the joint’s condition.
7. A healthcare provider performs an arthrotomy with biopsy on the carpometacarpal joint of a patient with suspected synovial inflammation.
8. During a surgical procedure, a surgeon opens the carpometacarpal joint and takes a biopsy to rule out any underlying joint pathology.
9. A patient with persistent wrist swelling undergoes an arthrotomy with biopsy on the carpometacarpal joint to investigate the cause of the swelling.
10. A healthcare provider performs an arthrotomy with biopsy on the carpometacarpal joint of a patient with a suspected joint infection.