How To Use CPT Code 26130

CPT 26130 describes the surgical procedure known as synovectomy, specifically targeting the carpometacarpal joint. This article will provide an overview of CPT code 26130, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26130?

CPT 26130 is a code used to describe the surgical procedure known as synovectomy, which involves the removal of the synovium, the membrane lining the carpometacarpal joint. This joint is located where a carpal bone of the wrist meets a metacarpal bone of the hand. Synovectomy is typically performed to treat conditions such as severe rheumatoid arthritis, juvenile idiopathic arthritis, or hemarthrosis, which involves bleeding in the joint.

2. Official Description

The official description of CPT code 26130 is: ‘Synovectomy, carpometacarpal joint.’

3. Procedure

1. During the procedure, the patient is appropriately prepped and anesthetized.
2. The healthcare provider makes an incision over the carpometacarpal joint near the wrist.
3. The incision is extended through the soft tissues and into the joint capsule surrounding the joint.
4. The provider visualizes the synovium, the membrane lining the joint, and identifies the inflamed or abnormal area.
5. The target area of the synovium is carefully removed.
6. A drain may be placed to assist with healing.
7. The incision is closed, and a splint may be applied.

4. Qualifying circumstances

CPT 26130 is typically performed on patients with conditions such as severe rheumatoid arthritis, juvenile idiopathic arthritis, or hemarthrosis. The procedure is intended to remove the inflamed or abnormal synovium from the carpometacarpal joint. It is important to note that this procedure should only be performed by a qualified healthcare provider.

5. When to use CPT code 26130

CPT code 26130 should be used when a synovectomy is performed on the carpometacarpal joint. It is important to ensure that the procedure is medically necessary and appropriate for the patient’s condition. This code should not be used for synovectomy procedures performed on other joints or for different indications.

6. Documentation requirements

To support a claim for CPT code 26130, the healthcare provider must document the following information:

• Patient’s diagnosis and the medical necessity of the synovectomy procedure
• Details of the procedure, including the specific joint targeted (carpometacarpal joint)
• Date of the procedure
• Incision site and approach
• Extent of synovium removal
• Use of drain, if applicable
• Application of splint, if applicable
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 26130, it is important to ensure that the procedure is performed on the carpometacarpal joint. The healthcare provider should follow the appropriate coding guidelines and ensure that the documentation supports the medical necessity of the procedure. It is also important to review any specific billing requirements from the payer to ensure accurate and timely reimbursement.

8. Historical information

CPT code 26130 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 patient with severe rheumatoid arthritis undergoes a synovectomy on the carpometacarpal joint to alleviate joint inflammation and pain.
2. A young patient with juvenile idiopathic arthritis requires a synovectomy on the carpometacarpal joint to improve hand function and reduce joint damage.
3. A patient with hemarthrosis in the carpometacarpal joint undergoes a synovectomy to address the bleeding and prevent further complications.
4. A healthcare provider performs a synovectomy on the carpometacarpal joint of a patient with chronic joint inflammation due to an autoimmune condition.
5. A synovectomy is performed on the carpometacarpal joint of a patient with persistent joint swelling and limited range of motion.
6. A patient with severe pain and inflammation in the carpometacarpal joint undergoes a synovectomy to improve their quality of life.
7. A synovectomy is performed on the carpometacarpal joint of a patient with recurrent joint effusion and inflammation.
8. A healthcare provider performs a synovectomy on the carpometacarpal joint of a patient with a history of trauma and subsequent joint damage.
9. A patient with chronic synovitis in the carpometacarpal joint undergoes a synovectomy to alleviate symptoms and prevent further joint deterioration.
10. A synovectomy is performed on the carpometacarpal joint of a patient with persistent joint stiffness and limited hand function.