How To Use CPT Code 26434

CPT 26434 describes the repair of the distal insertion of the extensor tendon using a graft. 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 26434?

CPT 26434 can be used to describe the repair of the distal insertion of the extensor tendon using a graft. This code is used when the provider performs an open approach to repair the tendon with sutures and a graft to prevent further deformity and complications.

2. Official Description

The official description of CPT code 26434 is: ‘Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft)’. There are no additional notes for this code.

3. Procedure

1. The provider prepares the patient and makes an incision above the tendon area, extending it down to the tendon level.
2. A graft is harvested from the palmaris longus tendon or a toe extensor tendon.
3. An incision is made over the graft site, a portion of the tendon is removed, and the incision is closed in layers.
4. The graft is sutured in the gap in the extensor tendon.
5. The provider controls any bleeding and closes the skin incision in layers.
6. An extension splint is applied to keep the joint in extension during healing.

4. Qualifying circumstances

Patients eligible to receive CPT 26434 services are those who require repair of the distal insertion of the extensor tendon using a graft. This procedure is performed to prevent further deformity and complications. The provider must use an open approach and perform the repair with sutures and a graft.

5. When to use CPT code 26434

CPT code 26434 should be used when the provider performs the repair of the distal insertion of the extensor tendon using a graft. This code can be used for both primary repairs, within one to seven days of the injury, and secondary repairs, more than seven days after the injury.

6. Documentation requirements

To support a claim for CPT 26434, the provider must document the following information:

• Patient’s diagnosis and the need for repair of the distal insertion of the extensor tendon
• Details of the graft used, including the source (palmaris longus tendon or toe extensor tendon)
• Date of the procedure
• Incision details and closure technique
• Details of the suturing and grafting procedure
• Any additional procedures performed, such as controlling bleeding or applying an extension splint
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26434, ensure that the provider performs the repair of the distal insertion of the extensor tendon using a graft. There are no specific guidelines regarding reporting this code with other codes. However, it is important to follow any applicable bundling or unbundling rules and to provide accurate documentation to support the claim.

8. Historical information

CPT 26434 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A hand surgeon performing a primary repair of the distal insertion of the extensor tendon using a graft obtained from the palmaris longus tendon.
2. An orthopedic surgeon performing a secondary repair of the distal insertion of the extensor tendon using a graft obtained from a toe extensor tendon.
3. A plastic surgeon repairing the distal insertion of the extensor tendon using a graft obtained from the palmaris longus tendon for a patient with mallet finger deformity.
4. An occupational therapist assisting a hand surgeon in the repair of the distal insertion of the extensor tendon using a graft obtained from a toe extensor tendon.
5. A hand therapist providing post-operative care for a patient who underwent a primary repair of the distal insertion of the extensor tendon using a graft obtained from the palmaris longus tendon.
6. A hand surgeon performing a secondary repair of the distal insertion of the extensor tendon using a graft obtained from a toe extensor tendon for a patient with a chronic extensor tendon injury.
7. An orthopedic surgeon repairing the distal insertion of the extensor tendon using a graft obtained from the palmaris longus tendon for a patient with a traumatic extensor tendon rupture.
8. A plastic surgeon performing a primary repair of the distal insertion of the extensor tendon using a graft obtained from a toe extensor tendon for a patient with a congenital extensor tendon deformity.
9. An occupational therapist assisting a hand surgeon in the repair of the distal insertion of the extensor tendon using a graft obtained from the palmaris longus tendon for a patient with a chronic extensor tendon injury.
10. A hand therapist providing post-operative care for a patient who underwent a secondary repair of the distal insertion of the extensor tendon using a graft obtained from a toe extensor tendon.