How To Use CPT Code 26428

CPT 26428 describes the repair of the extensor tendon, specifically the central slip, in cases 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 26428?

CPT 26428 is used to describe the repair of the extensor tendon, specifically the central slip, in cases of a boutonniere deformity. This procedure involves placing a graft in the central slip to lengthen it and restore function and flexibility to the finger.

2. Official Description

The official description of CPT code 26428 is: ‘Repair of extensor tendon, central slip, secondary (e.g., boutonniere deformity); with free graft (includes obtaining graft), 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 provider secures the central slip to the middle phalanx with sutures and restores extension to the proximal interphalangeal (PIP) joint, which is the joint nearest the knuckle of the finger.
4. The provider splits the lateral bands lengthwise and sutures them together in the midline, creating a functional central slip.
5. If a graft is needed, the provider removes a portion of the palmaris longus tendon, an extensor tendon from a toe, or tissue from another location.
6. The provider excises the graft, repairs the tendon, and closes the skin incision.
7. Alternatively, the provider may elongate the extensor digiti minimi with a free tendon graft and transfer it to the base of the middle phalanx.
8. The provider controls any bleeding, removes all instruments, and closes the incision in layers.

4. Qualifying circumstances

CPT 26428 is used in cases of a boutonniere deformity, which occurs when the extensor tendon is stretched at the proximal interphalangeal (PIP) joint. The central slip of the extensor tendon becomes disrupted at its point of insertion into the base of the middle phalanx, resulting in the inability to fully extend the joint. This procedure is performed to repair the boutonniere deformity and restore function and flexibility to the finger.

5. When to use CPT code 26428

CPT code 26428 should be used when a graft has been harvested and used in the repair of the extensor tendon for a boutonniere deformity. If no graft was used, CPT code 26426 should be used instead.

6. Documentation requirements

To support a claim for CPT code 26428, the provider must document the following information:

• Patient’s diagnosis of a boutonniere deformity
• Use of a graft in the repair of the extensor tendon
• Date of the procedure
• Details of the procedure, including the incision, suturing, and grafting techniques
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT code 26428, ensure that the procedure involves the repair of the extensor tendon, specifically the central slip, for a boutonniere deformity. Use the appropriate CPT code based on the use of a graft in the procedure. It is important to follow the specific documentation requirements and guidelines provided by the payer.

8. Historical information

CPT code 26428 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 middle finger. The provider performs a repair of the extensor tendon, central slip, using a free graft to restore function and flexibility to the finger.
2. A patient has a boutonniere deformity in their ring finger. The provider performs a repair of the extensor tendon, central slip, using a palmaris longus tendon graft to correct the deformity.
3. A patient with a boutonniere deformity in their index finger undergoes a repair of the extensor tendon, central slip, with a toe extensor tendon graft to improve finger extension.
4. A patient presents with a boutonniere deformity in their little finger. The provider performs a repair of the extensor tendon, central slip, using a tissue graft from the patient’s forearm to restore normal finger function.
5. A patient has a boutonniere deformity in their thumb. The provider performs a repair of the extensor tendon, central slip, using a graft from the patient’s great toe to correct the deformity.
6. A patient with a boutonniere deformity in their middle finger undergoes a repair of the extensor tendon, central slip, with an extensor digiti minimi tendon graft to restore finger extension.