How To Use CPT Code 26494

CPT 26494 describes a surgical procedure known as opponensplasty, which involves the transfer of a tendon to restore the opposition function of the thumb. This article will provide a comprehensive overview of CPT code 26494, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 26494?

CPT 26494 is a code used to describe the surgical procedure called opponensplasty. This procedure involves the transfer of a tendon 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 purpose of this procedure is to improve the patient’s hand function and overall quality of life.

2. Official Description

The official description of CPT code 26494 is: ‘Opponensplasty; hypothenar muscle transfer.’

3. Procedure

1. The surgeon begins by making an incision in the skin over the ulnar side of the palm.
2. They then dissect through the subcutaneous tissue to expose the tendon.
3. The hypothenar muscle tendon is isolated and separated from its attachment.
4. The surgeon redirects the tendon to the thumb and sutures it to the metacarpophalangeal joint of the thumb at the point of attachment of the abductor pollicis brevis muscle.
5. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 26494 is performed on patients who require restoration of thumb opposition function. This procedure is typically indicated for individuals with conditions or injuries that have resulted in the loss or impairment of thumb opposition. The patient must be evaluated by a qualified healthcare professional who determines that opponensplasty is the appropriate treatment option. The procedure is performed by a surgeon who has the necessary expertise and training in hand and upper extremity surgery.

5. When to use CPT code 26494

CPT code 26494 should be used when a surgeon performs the opponensplasty procedure to restore thumb opposition function. This code is specific to the hypothenar muscle transfer technique. It should not be used for other types of tendon transfers or surgical techniques. It is important to accurately document the details of the procedure to support the use of CPT code 26494.

6. Documentation requirements

To support a claim for CPT code 26494, the surgeon must document the following information:

• Patient’s diagnosis or condition necessitating the opponensplasty procedure
• Details of the surgical technique used, specifically the hypothenar muscle transfer
• Date of the procedure
• Any additional procedures performed in conjunction with opponensplasty
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and follow-up plans

7. Billing guidelines

When billing for CPT code 26494, it is important to ensure that the procedure performed aligns with the official description of the code. The surgeon should accurately document the details of the procedure to support the use of this code. It is also essential to follow any specific billing guidelines provided by the payer or insurance company. Additionally, it is important to review any applicable modifiers or additional codes that may be required for accurate billing.

8. Historical information

CPT code 26494 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 opposition impairment due to a traumatic injury undergoes opponensplasty using the hypothenar muscle transfer technique.
2. An individual with a congenital condition that affects thumb opposition function undergoes opponensplasty to improve hand function.
3. A patient with thumb arthritis undergoes opponensplasty to alleviate pain and restore thumb opposition.
4. An individual with a neurological condition that has resulted in the loss of thumb opposition undergoes opponensplasty to improve hand dexterity.
5. A patient with a thumb tendon injury undergoes opponensplasty to restore thumb opposition and regain normal hand function.
6. An individual with a thumb deformity undergoes opponensplasty to correct the deformity and improve hand function.
7. A patient with thumb opposition impairment due to a degenerative condition undergoes opponensplasty to restore thumb function and improve quality of life.
8. An individual with a thumb injury that has resulted in the loss of opposition undergoes opponensplasty to regain thumb function and improve hand grip.
9. A patient with a thumb tendon rupture undergoes opponensplasty to restore thumb opposition and improve hand function.
10. An individual with a thumb joint disease undergoes opponensplasty to alleviate pain and improve thumb movement.