How To Use CPT Code 26498

CPT 26498 describes the transfer of tendons from one location to another in order to restore the intrinsic function of all four fingers. 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 26498?

CPT 26498 can be used to describe the surgical procedure in which the provider transfers tendons from one location to another to restore the intrinsic function of all four fingers. This procedure is performed to correct the deformity known as claw hand, which is characterized by hyperextension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints.

2. Official Description

The official description of CPT code 26498 is: ‘Transfer of tendon to restore intrinsic function; all four fingers.’

3. Procedure

1. The provider makes an incision in the skin and dissects down to reach the tendons involved in the deformity.
2. The affected flexor tendons are separated from their original insertion points.
3. The provider fixes the tendons to the extensor mechanism of the hand, transferring them to restore the intrinsic function of the hand.
4. Hemostasis is achieved at the surgical site and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 26498 is performed on patients who have lost the intrinsic function of their hand, resulting in the claw hand deformity. This procedure is appropriate for individuals who require restoration of the grasp and have not responded to non-surgical interventions. The patient must be evaluated by a provider who determines the need for tendon transfer and confirms that the procedure is medically necessary.

5. When to use CPT code 26498

CPT code 26498 should be used when the provider performs a tendon transfer procedure to restore the intrinsic function of all four fingers. It is important to ensure that the patient meets the qualifying circumstances and that the procedure is medically necessary. This code should not be used for other types of tendon transfers or procedures on different fingers.

6. Documentation requirements

To support a claim for CPT 26498, the provider must document the following information:

• Patient’s diagnosis and the need for tendon transfer to restore intrinsic function
• Details of the procedure, including the specific tendons involved and the location of the transfer
• Date of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and follow-up plans
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26498, ensure that the procedure meets the qualifying circumstances and is medically necessary. It is important to use the appropriate CPT code based on the specific procedure performed. CPT code 26498 should not be reported with other codes unless there are additional procedures or services performed that are separately identifiable and distinct from the tendon transfer procedure.

8. Historical information

CPT 26498 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 claw hand deformity undergoes a tendon transfer procedure on all four fingers to restore intrinsic function.
2. A provider performs a tendon transfer procedure on a patient with loss of grasp due to intrinsic muscle dysfunction in all four fingers.
3. A patient with hyperextension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints undergoes a tendon transfer procedure on all four fingers to correct the claw hand deformity.
4. A provider performs a tendon transfer procedure on a patient with loss of intrinsic function in all four fingers, resulting in the claw hand deformity.
5. A patient with impaired grasp due to intrinsic muscle dysfunction in all four fingers undergoes a tendon transfer procedure to restore hand function.
6. A provider performs a tendon transfer procedure on a patient with claw hand deformity, transferring tendons to restore the intrinsic function of all four fingers.
7. A patient with hyperextension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints undergoes a tendon transfer procedure on all four fingers to improve hand function.
8. A provider performs a tendon transfer procedure on a patient with loss of grasp and claw hand deformity in all four fingers.
9. A patient with impaired hand function due to intrinsic muscle dysfunction in all four fingers undergoes a tendon transfer procedure to restore grasp.
10. A provider performs a tendon transfer procedure on a patient with claw hand deformity, transferring tendons to restore the intrinsic function of all four fingers.