How To Use CPT Code 26525

CPT 26525 describes a procedure known as capsulectomy or capsulotomy, specifically for the interphalangeal joint of each finger. This article will provide an overview of CPT code 26525, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26525?

CPT 26525 is a code used to describe a surgical procedure performed by a healthcare provider to release joint contracture in the interphalangeal joint of each finger. This procedure involves making an incision or excising the joint capsule between two phalanges of the finger to restore joint movement and alleviate contracture.

2. Official Description

The official description of CPT code 26525 is: ‘Capsulectomy or capsulotomy; interphalangeal joint, each joint.’

3. Procedure

1. After appropriate patient preparation and anesthesia, the healthcare provider makes an incision on the back of the hand over the joint between two phalanges.
2. The incision is taken down to the level of the joint capsule, while preserving the nerves passing over it using retractors.
3. Using a combination of sharp and blunt dissection, the provider separates the attached tendon from the joint capsule.
4. The provider then either makes a full-thickness incision into the joint capsule to release the contracture or removes the capsule if scarring is dense.
5. After the procedure, the provider checks the movement of the joint to ensure satisfactory results.
6. The tendon is sutured back, and the surgical wound is closed.

4. Qualifying circumstances

CPT 26525 is performed on patients with joint contracture in the interphalangeal joint of their fingers. Joint contracture refers to the permanent tightening of nonbony tissues, such as muscles, tendons, ligaments, or skin. This procedure is typically performed by a healthcare provider to restore joint movement and alleviate contracture when other non-surgical interventions have been unsuccessful.

5. When to use CPT code 26525

CPT code 26525 should be used when a healthcare provider performs a capsulectomy or capsulotomy on the interphalangeal joint of each finger to release joint contracture. It is important to note that this code should be reported separately for each joint capsule treated.

6. Documentation requirements

To support a claim for CPT 26525, the healthcare provider must document the following information:

• Patient’s diagnosis and the presence of joint contracture
• Details of the procedure performed, including the specific joint capsule treated
• Date of the procedure
• Any additional procedures or interventions performed during the same session
• Post-procedure assessment of joint movement and any follow-up plans
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 26525, ensure that the procedure is performed on the interphalangeal joint of each finger. It is important to report this code separately for each joint capsule treated. Consider any additional procedures or interventions performed during the same session and report them accordingly. Review the specific billing guidelines provided by payers to ensure accurate and appropriate reimbursement.

8. Historical information

CPT code 26525 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 healthcare provider performs a capsulectomy on the interphalangeal joint of the index finger to release joint contracture.
2. A patient with joint contracture in the interphalangeal joint of their middle finger undergoes a capsulotomy procedure to restore joint movement.
3. A healthcare provider performs a capsulectomy on the interphalangeal joint of the ring finger to alleviate joint contracture.
4. A capsulotomy is performed on the interphalangeal joint of the little finger to release joint contracture and improve finger movement.
5. A patient with joint contracture in the interphalangeal joint of their thumb undergoes a capsulectomy procedure to restore joint mobility.
6. A healthcare provider performs a capsulotomy on the interphalangeal joint of the index finger to alleviate joint contracture and improve finger function.
7. A capsulectomy is performed on the interphalangeal joint of the middle finger to release joint contracture and improve finger flexibility.
8. A patient with joint contracture in the interphalangeal joint of their ring finger undergoes a capsulotomy procedure to restore joint movement and alleviate discomfort.
9. A healthcare provider performs a capsulectomy on the interphalangeal joint of the little finger to alleviate joint contracture and improve finger dexterity.
10. A capsulotomy is performed on the interphalangeal joint of the thumb to release joint contracture and improve thumb function.