How To Use CPT Code 26531

CPT 26531 describes a specific procedure involving the metacarpophalangeal joint, which is the joint between the metacarpal bones and the phalanges in the hand. This article will provide an overview of CPT code 26531, 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 26531?

CPT 26531 is a code used to describe a surgical procedure that involves the metacarpophalangeal joint. This procedure typically includes the excision of part or all of one or more of the metacarpal bones and the placement of a silicone spacer in the joint. The purpose of this procedure is to correct deformities, reduce inflammation, and improve the function of the joint.

2. Official Description

The official description of CPT code 26531 is: ‘Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. An incision is made over the metacarpophalangeal joint to expose the neck and heads of the metacarpal bones.
3. Tendon and capsule releases may be performed to further expose the joint.
4. Part or all of one or more of the metacarpal heads are excised.
5. A silicone spacer is inserted to replace the excised bone, maintaining the space between the bones and reducing their mobility.
6. The capsule over the metacarpals is closed, and the extensor tendons are realigned.
7. Bleeding is controlled, instruments are removed, and the incision is closed in layers.

4. Qualifying circumstances

CPT 26531 is typically performed on patients who have deformities, inflammation, or functional issues in their metacarpophalangeal joint. The procedure is intended to improve the patient’s condition and may be necessary when other non-surgical treatments have been unsuccessful. It is important to note that each joint replaced requires a separate reporting of CPT code 26531.

5. When to use CPT code 26531

CPT code 26531 should be used when a surgical procedure is performed on the metacarpophalangeal joint, specifically involving the excision of part or all of one or more metacarpal bones and the placement of a silicone spacer. This code should be used for each joint that undergoes the procedure.

6. Documentation requirements

To support a claim for CPT 26531, the following documentation is typically required:

• Preoperative diagnosis and indication for the procedure
• Details of the procedure performed, including the specific metacarpophalangeal joint involved
• Description of the excision and placement of the silicone spacer
• Any additional procedures performed, such as tendon or capsule releases
• Any complications or unexpected findings during the procedure
• Postoperative diagnosis and prognosis
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 26531, it is important to ensure that the procedure performed matches the description of the code. Each joint that undergoes the procedure should be reported separately. It is also important to check with the payer for any specific requirements or preauthorization needed for this procedure. Additionally, it is crucial to follow any applicable coding guidelines and modifiers when reporting CPT 26531.

8. Historical information

CPT code 26531 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 undergoes CPT 26531 for the excision of part of the metacarpal bone and placement of a silicone spacer in their right metacarpophalangeal joint to correct a deformity.
2. A surgeon performs CPT 26531 on a patient’s left metacarpophalangeal joint to reduce inflammation and improve function.
3. A patient with a functional issue in their right metacarpophalangeal joint undergoes CPT 26531 to excise part of the metacarpal bone and insert a silicone spacer.
4. CPT 26531 is performed on a patient’s left metacarpophalangeal joint to correct a deformity and improve their hand function.
5. A surgeon uses CPT 26531 to excise part of the metacarpal bone and place a silicone spacer in a patient’s right metacarpophalangeal joint to reduce inflammation and improve their hand function.
6. A patient undergoes CPT 26531 on their left metacarpophalangeal joint to correct a deformity and improve their hand function.
7. CPT 26531 is performed on a patient’s right metacarpophalangeal joint to excise part of the metacarpal bone and insert a silicone spacer to reduce inflammation and improve function.
8. A surgeon uses CPT 26531 to excise part of the metacarpal bone and place a silicone spacer in a patient’s left metacarpophalangeal joint to correct a deformity and improve their hand function.
9. A patient undergoes CPT 26531 on their right metacarpophalangeal joint to reduce inflammation and improve their hand function.