How To Use CPT Code 26426

CPT 26426 describes the repair of the extensor tendon’s central slip, specifically for the treatment of a boutonniere deformity. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26426?

CPT 26426 is used to describe the repair of the central slip of the extensor tendon in the hand. This procedure is performed to correct a boutonniere deformity, which is a finger deformity where the proximal interphalangeal joint bends towards the palm while the distal interphalangeal joint bends in the opposite direction. The repair involves manipulating local tissue and the lateral bands to hold the tendon in place close to the bone, restoring function and flexibility to the finger.

2. Official Description

The official description of CPT code 26426 is: ‘Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each finger.’

3. Procedure

1. The provider makes a longitudinal incision over the distal interphalangeal (DIP) joint, which is the joint at the end of the finger.
2. The provider may perform a tenotomy of the distal tendon to release the hyperextension of the DIP joint.
3. The central slip of the extensor tendon is secured to the middle phalanx with sutures.
4. The lateral bands, which hold the tendon close to the bone, are split lengthwise and sutured together in the midline to create a functional central slip.
5. Any bleeding is controlled, instruments are removed, and the incision is closed in layers.

4. Qualifying circumstances

CPT 26426 is performed for patients with a boutonniere deformity, which occurs when the extensor tendon is stretched at the proximal interphalangeal joint. The procedure is intended to restore the central slip of the extensor tendon and correct the deformity. It is important to note that this code is specific to each finger, and multiple codes should be used if the repair is performed on multiple fingers.

5. When to use CPT code 26426

CPT code 26426 should be used when the provider performs a repair of the central slip of the extensor tendon to correct a boutonniere deformity. It is important to ensure that the documentation supports the specific procedure performed and the medical necessity for the repair.

6. Documentation requirements

To support a claim for CPT 26426, the provider must document the following information:

• Diagnosis of a boutonniere deformity
• Details of the repair procedure, including the use of local tissue and lateral bands
• Date of the procedure
• Any additional procedures performed, such as a tenotomy of the distal tendon
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26426, ensure that the documentation supports the repair of the central slip of the extensor tendon for a boutonniere deformity. It is important to use the appropriate code for each finger that undergoes the repair. Additionally, follow any specific billing guidelines provided by the payer to ensure accurate reimbursement.

8. Historical information

CPT code 26426 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 presents with a boutonniere deformity in their right index finger. The provider performs a repair of the central slip of the extensor tendon using local tissue and lateral bands.
2. A patient has a boutonniere deformity in their left middle finger. The provider performs a repair of the central slip of the extensor tendon, including a tenotomy of the distal tendon, to correct the deformity.
3. A patient undergoes a repair of the central slip of the extensor tendon in their right ring finger to correct a boutonniere deformity. The procedure involves suturing the central slip to the middle phalanx and suturing the lateral bands together.
4. A provider performs a repair of the central slip of the extensor tendon in the patient’s left little finger to correct a boutonniere deformity. The procedure includes splitting and suturing the lateral bands to create a functional central slip.
5. A patient presents with a boutonniere deformity in their right thumb. The provider performs a repair of the central slip of the extensor tendon, securing it to the middle phalanx with sutures and suturing the lateral bands together.