How To Use CPT Code 26492

CPT 26492 describes a surgical procedure called opponensplasty, which involves the transfer of a tendon with a graft to restore the opposition function of the thumb. 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 26492?

CPT 26492 is a code used to describe the surgical procedure known as opponensplasty. This procedure involves the transfer of a tendon with a graft to restore the opposition function of the thumb. Thumb opposition refers to the ability of the thumb to move across the palm and oppose the other fingertips. The code is used when a provider performs this procedure on each tendon that requires transfer with a graft.

2. Official Description

The official description of CPT code 26492 is: ‘Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes an incision in the skin of the finger and dissects through the subcutaneous tissue to expose the tendon.
3. The provider isolates the tendon and separates it from its attachment.
4. A graft is obtained from the palmaris longus or plantaris tendon to augment the transferred tendon.
5. The provider attaches the graft to the muscle tendon to ensure sufficient length for transfer.
6. The provider sutures the tendon to the metacarpophalangeal joint of the thumb at the point of attachment of the abductor pollicis brevis muscle.
7. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 26492 is performed on patients who require restoration of thumb opposition function through tendon transfer with a graft. This procedure is typically indicated for patients with thumb dysfunction or injury that affects their ability to perform activities requiring thumb opposition. The procedure is performed by a qualified healthcare provider who has the necessary expertise in performing opponensplasty.

5. When to use CPT code 26492

CPT code 26492 should be used when a provider performs opponensplasty by transferring a tendon with a graft to restore thumb opposition function. This code should be reported for each tendon that requires transfer with a graft. It is important to note that CPT code 26492 should not be reported separately for obtaining the graft, as it is already included in the code description.

6. Documentation requirements

To support a claim for CPT code 26492, the provider must document the following information:

• Patient’s diagnosis and the need for opponensplasty
• Details of the procedure, including the specific tendon transferred and the graft used
• Date of the procedure
• Any additional procedures performed in conjunction with opponensplasty
• Any complications or unexpected findings during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 26492, ensure that the procedure meets the criteria outlined in the code description. It is important to report one unit of this code for each tendon transferred with a graft. Do not report the procedure of obtaining the graft separately, as it is already included in the code description. Additionally, be aware of other codes that may be relevant to the procedure and follow any specific guidelines provided by payers.

8. Historical information

CPT code 26492 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 thumb dysfunction undergoes opponensplasty with tendon transfer and graft to restore thumb opposition function.
2. A provider performs opponensplasty on a patient who sustained a thumb injury, transferring the tendon with a graft to restore thumb opposition.
3. A patient with thumb dysfunction due to a medical condition undergoes opponensplasty with tendon transfer and graft to improve thumb function.
4. A provider performs opponensplasty on a patient with thumb dysfunction caused by a previous surgery, transferring the tendon with a graft to restore thumb opposition.
5. A patient with thumb dysfunction resulting from a traumatic injury undergoes opponensplasty with tendon transfer and graft to restore thumb opposition function.
6. A provider performs opponensplasty on a patient with thumb dysfunction caused by a degenerative condition, transferring the tendon with a graft to improve thumb function.
7. A patient with thumb dysfunction due to a congenital anomaly undergoes opponensplasty with tendon transfer and graft to restore thumb opposition.
8. A provider performs opponensplasty on a patient with thumb dysfunction caused by a nerve injury, transferring the tendon with a graft to restore thumb opposition function.
9. A patient with thumb dysfunction resulting from a sports-related injury undergoes opponensplasty with tendon transfer and graft to improve thumb function.
10. A provider performs opponensplasty on a patient with thumb dysfunction caused by a chronic inflammatory condition, transferring the tendon with a graft to restore thumb opposition.