How To Use CPT Code 26516

CPT 26516 describes a procedure called capsulodesis, which is used to treat instability of the joint between a metacarpal bone and the proximal phalanx in a single digit. 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 26516?

CPT 26516 is a code that represents the capsulodesis procedure, which is performed to address joint instability between a metacarpal bone and the proximal phalanx in a single digit. This procedure involves making an incision on the palmar side of the hand over the affected joint, freeing the joint capsule from the bones, roughening the surface of the metacarpal head and proximal phalanx, and then suturing or affixing the capsule with wires to provide stability. It is important to note that this code specifically applies to work on a single digit.

2. Official Description

The official description of CPT code 26516 is: ‘Capsulodesis, metacarpophalangeal joint; single digit.’

3. Procedure

1. To perform capsulodesis, the provider begins by making an S-shaped incision on the palmar side of the hand over the joint between the metacarpal and proximal phalanx.
2. The incision is then taken down to the level of the joint capsule.
3. The provider carefully frees the joint capsule from the bones, ensuring that it is fully mobilized.
4. Next, the provider roughens the surface of the metacarpal head and the end of the proximal phalanx to promote better adhesion.
5. The provider then sutures the capsule onto the bony tissue or affixes it with wires, applying appropriate tension to ensure stability.
6. Once stability is confirmed, the operative site is closed with sutures.

4. Qualifying circumstances

CPT 26516 is used when a patient presents with joint instability between a metacarpal bone and the proximal phalanx in a single digit. This procedure is typically performed to address instability caused by injury or disease of the joint capsule. It is important to note that this code specifically applies to work on a single digit.

5. When to use CPT code 26516

CPT code 26516 should be used when a provider performs the capsulodesis procedure on a single digit to treat joint instability between a metacarpal bone and the proximal phalanx. It is important to ensure that the procedure is performed on the appropriate digit and that the joint instability meets the criteria for capsulodesis.

6. Documentation requirements

To support a claim for CPT code 26516, the provider must document the following information:

• The diagnosis indicating joint instability between a metacarpal bone and the proximal phalanx in a single digit
• A detailed description of the procedure performed, including the specific steps taken
• The date of the procedure
• Any additional findings or complications encountered during the procedure
• Confirmation of stability after the capsulodesis procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 26516, it is important to ensure that the procedure is performed on a single digit and that the documentation supports the medical necessity of the capsulodesis. It is also important to follow any specific billing guidelines provided by the payer. Additionally, it is important to consider any applicable modifiers or additional codes that may be required for accurate billing.

8. Historical information

CPT code 26516 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 hand surgeon performing capsulodesis on the metacarpophalangeal joint of the index finger to address joint instability.
2. An orthopedic surgeon performing capsulodesis on the metacarpophalangeal joint of the thumb to treat joint instability caused by injury.
3. A plastic surgeon performing capsulodesis on the metacarpophalangeal joint of the little finger to address joint instability resulting from a degenerative condition.
4. An occupational therapist assisting a patient with joint instability in the middle finger by performing capsulodesis.
5. A hand therapist performing capsulodesis on the metacarpophalangeal joint of the ring finger to address joint instability caused by a previous injury.
6. A hand surgeon performing capsulodesis on the metacarpophalangeal joint of the thumb to treat joint instability resulting from a chronic condition.
7. An orthopedic surgeon performing capsulodesis on the metacarpophalangeal joint of the index finger to address joint instability caused by repetitive strain.
8. A plastic surgeon performing capsulodesis on the metacarpophalangeal joint of the little finger to treat joint instability resulting from a congenital condition.
9. An occupational therapist assisting a patient with joint instability in the middle finger by performing capsulodesis.
10. A hand therapist performing capsulodesis on the metacarpophalangeal joint of the ring finger to address joint instability caused by a previous injury.