How To Use CPT Code 26542

CPT 26542 describes a specific procedure for the repair of the collateral ligament in the metacarpophalangeal joint of the hand. This article will provide an overview of CPT code 26542, 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 26542?

CPT 26542 is a code used to describe a surgical procedure that involves the reconstruction of the collateral ligament in the metacarpophalangeal joint of the hand. This ligament is responsible for holding the joint between the hand’s metacarpal and the finger’s proximal phalanx together from the sides. The procedure is typically performed when there is a partial tear in the ligament, and the provider uses a nearby tendon to repair the damaged part.

2. Official Description

The official description of CPT code 26542 is: ‘Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement).’ This description indicates that the procedure involves the reconstruction of the collateral ligament using local tissue, such as an adductor advancement technique.

3. Procedure

1. During the procedure, the provider makes a longitudinal incision on the side of the affected joint between the metacarpal of the hand and the proximal phalanx of the finger.
2. The provider then exposes the collateral ligament and preserves the blood and nerve supply using a retractor.
3. Next, the provider detaches the adductor tendon from a small sesamoid or other bone near the metacarpal.
4. The provider affixes the tendon to the proximal phalanx by either using pins or sutures after drilling holes for attachment.
5. After confirming the desired movement and stability of the joint, the provider irrigates the operative site with antibiotics and closes the wound with sutures.

4. Qualifying circumstances

CPT 26542 is typically performed on patients who have a partial tear in the collateral ligament of the metacarpophalangeal joint. The procedure is intended to restore stability and function to the joint. It is important to note that this procedure is specific to the metacarpophalangeal joint and should not be used for other joints or ligaments.

5. When to use CPT code 26542

CPT code 26542 should be used when a provider performs a reconstruction of the collateral ligament in the metacarpophalangeal joint of the hand using local tissue, such as an adductor advancement technique. It is important to ensure that the procedure is performed on the appropriate joint and ligament, as using this code for other joints or ligaments would be incorrect.

6. Documentation requirements

To support a claim for CPT code 26542, the provider must document the following information:

• Patient’s diagnosis and the need for collateral ligament reconstruction
• Details of the procedure performed, including the use of local tissue and any specific techniques used
• Date of the procedure
• Any additional procedures or services performed during the same operative session
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 26542, it is important to ensure that the procedure performed matches the description provided in the code. The provider should also ensure that the documentation supports the medical necessity of the procedure. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 26542 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 a reconstruction of the collateral ligament in the metacarpophalangeal joint of their hand using an adductor advancement technique.
2. A provider performs a repair of the collateral ligament in the metacarpophalangeal joint without the use of local tissue.
3. A patient undergoes a reconstruction of the collateral ligament in the metacarpophalangeal joint with the use of a graft.
4. A provider performs a reconstruction of the collateral ligament in the metacarpophalangeal joint with the use of a tendon transfer.
5. A patient undergoes a reconstruction of the collateral ligament in the metacarpophalangeal joint with the use of a joint capsule or ligamentous graft.