How To Use CPT Code 26536

CPT 26536 describes the procedure of arthroplasty, specifically for the interphalangeal joint. 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 26536?

CPT 26536 describes a surgical procedure known as arthroplasty, which involves the reconstruction or replacement of one or more interphalangeal joints with an artificial implant. This procedure is typically performed to correct deformities, reduce inflammation, and improve the overall function of the joint. It is commonly used in patients with arthritis or prior injuries affecting the interphalangeal joints.

2. Official Description

The official description of CPT code 26536 is: ‘Arthroplasty, interphalangeal joint; with prosthetic implant, each joint.’

3. Procedure

1. During the procedure, the healthcare provider makes an incision over the affected interphalangeal joint.
2. They then remove a portion of one or more of the respective bones to create space for the prosthetic implant.
3. The provider carefully inserts the artificial implant, which is typically made of silicone or metal, between the bones.
4. If necessary, the implant may include hinges to allow for proper movement of the finger.
5. The provider closes the joint capsule and ensures there is no excessive bleeding.
6. Finally, they remove all instruments and close the incision in layers.

4. Qualifying circumstances

CPT 26536 is used for patients who require arthroplasty of the interphalangeal joint due to conditions such as arthritis, joint deformities, or prior injuries. The procedure is performed by a healthcare provider to correct ankylosis, repair cartilage damage, or address joint dislocations. It is important to note that this code is specific to each joint, and multiple codes should be used if multiple joints are involved.

5. When to use CPT code 26536

CPT code 26536 should be used when a healthcare provider performs arthroplasty on an interphalangeal joint, utilizing a prosthetic implant. This code is appropriate for each joint that undergoes the procedure. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 26536, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the arthroplasty
• Details of the procedure, including the specific joint(s) involved
• Implant used for the arthroplasty
• Date of the procedure
• Any additional relevant information, such as complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 26536, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should report this code once for each interphalangeal joint that undergoes arthroplasty. Some payers may require preauthorization for this procedure, so it is essential to check with the payer’s requirements. Additionally, certain payers may require the use of HCPCS Level II modifiers to identify the specific fingers operated on.

8. Historical information

CPT code 26536 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 arthroplasty on the interphalangeal joint of a patient’s index finger, using a prosthetic implant.
2. Arthroplasty is performed on the interphalangeal joint of a patient’s middle finger, utilizing a prosthetic implant.
3. A healthcare provider conducts arthroplasty on the interphalangeal joint of a patient’s ring finger, with the insertion of a prosthetic implant.
4. Arthroplasty is performed on the interphalangeal joint of a patient’s little finger, using a prosthetic implant.
5. A healthcare provider performs arthroplasty on the interphalangeal joint of a patient’s thumb, utilizing a prosthetic implant.
6. Arthroplasty is conducted on the interphalangeal joint of a patient’s big toe, with the insertion of a prosthetic implant.
7. A healthcare provider performs arthroplasty on the interphalangeal joint of a patient’s second toe, using a prosthetic implant.
8. Arthroplasty is performed on the interphalangeal joint of a patient’s third toe, utilizing a prosthetic implant.
9. A healthcare provider conducts arthroplasty on the interphalangeal joint of a patient’s fourth toe, with the insertion of a prosthetic implant.
10. Arthroplasty is performed on the interphalangeal joint of a patient’s fifth toe, using a prosthetic implant.