How To Use CPT Code 26535

CPT 26535 describes a procedure that involves the reconstruction or replacement of one or more interphalangeal joints in the hand. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26535?

CPT 26535 is a code used to describe a surgical procedure that involves the reconstruction or replacement of one or more interphalangeal joints in the hand. This procedure is typically performed to correct deformities, reduce inflammation, and improve the function of the affected joints. It is commonly performed on patients who have arthritis or have experienced prior injuries to the hand.

2. Official Description

The official description of CPT code 26535 is: ‘Arthroplasty, interphalangeal joint; each joint.’

3. Procedure

1. The provider begins by making an incision over the affected interphalangeal joint.
2. They then excise part of one or more of the respective bones to create space for the reconstruction or replacement.
3. A piece of soft tissue, such as a rolled-up tendon or a piece of fascia, is inserted between the bones to act as a spacer and create a fibrous ankylosis.
4. The provider closes the joint capsule and ensures there is no bleeding.
5. All instruments are removed, and the incision is closed in layers.

4. Qualifying circumstances

CPT 26535 is typically performed on patients who have arthritis or have experienced prior injuries to the interphalangeal joints in their hand. The procedure is intended to correct deformities, reduce inflammation, and improve the function of the affected joints. It is important to note that each joint that undergoes arthroplasty should be reported separately using CPT code 26535.

5. When to use CPT code 26535

CPT code 26535 should be used when a provider performs arthroplasty on one or more interphalangeal joints in the hand. It is important to report this code for each joint that undergoes the procedure. However, it is essential to check with the payer for any specific requirements or preauthorization needed for this procedure.

6. Documentation requirements

To support a claim for CPT 26535, the provider must document the following information:

• The specific interphalangeal joint(s) that underwent arthroplasty
• A description of the procedure performed, including any modifications or variations
• Date of the procedure
• Any preoperative or postoperative diagnoses
• Details of the patient’s condition and the need for the procedure
• Any complications or unexpected findings during the procedure
• Any additional procedures performed during the same operative session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26535, it is important to ensure that the procedure was performed on the interphalangeal joint(s) and that each joint is reported separately. Some payers may require the use of HCPCS Level II modifiers to identify the specific fingers that underwent the procedure. It is also important to check with the payer for any specific requirements or preauthorization needed for this procedure.

8. Historical information

CPT code 26535 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 arthritis undergoes arthroplasty on the interphalangeal joint of their index finger.
2. A patient with a previous injury to their middle finger undergoes arthroplasty on the interphalangeal joint to correct the deformity.
3. A patient with arthritis in both their ring and little fingers undergoes arthroplasty on both interphalangeal joints.
4. A patient with a dislocated interphalangeal joint in their thumb undergoes arthroplasty to improve function and reduce inflammation.
5. A patient with arthritis in multiple interphalangeal joints undergoes arthroplasty on each affected joint to improve their hand function.
6. A patient with a history of trauma to their hand undergoes arthroplasty on the interphalangeal joint of their pinky finger.
7. A patient with severe deformity in their middle finger undergoes arthroplasty to correct the alignment and improve function.
8. A patient with chronic inflammation in their ring finger undergoes arthroplasty to reduce pain and improve joint mobility.
9. A patient with arthritis in their thumb interphalangeal joint undergoes arthroplasty to alleviate symptoms and improve hand function.
10. A patient with a previous injury to their index finger undergoes arthroplasty to restore joint stability and function.