How To Use CPT Code 26551

CPT 26551 describes the transfer of the great toe to the hand with microvascular anastomosis, including the use of a bone graft. 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 26551?

CPT 26551 can be used to describe the transfer of the great toe to the hand with microvascular anastomosis, specifically for patients who are missing a thumb due to trauma or a congenital absence. The procedure involves removing the great toe from the foot, along with its related blood vessels, nerves, bones, and tendons, and transplanting it to the hand using a bone graft.

2. Official Description

The official description of CPT code 26551 is: ‘Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with bone graft.’ This code is used when the provider reconstructs the thumb using the great toe, which is similar in shape and size to the thumb.

3. Procedure

1. The provider begins by making a circular incision on the dorsal surface of the great toe to create flaps on the inner and outer side of the toe.
2. Next, the provider dissects down through the subcutaneous tissue and carefully incises the dorsalis pedis artery and first dorsal metatarsal artery.
3. The provider then makes an incision underneath the great toe and isolates the digital nerves.
4. Using microsurgical techniques, the provider separates the flap, including a portion of the nail and distal phalanx, while preserving the blood vessels, nerves, bone, and tendons.
5. The provider closes the donor site wound with the help of a skin graft and covers it with a sterile bandage.
6. At the same time, another surgical team prepares the stump of the thumb on the hand to accept the graft and obtains an iliac bone graft.
7. Using microsurgical techniques and an operating microscope, the provider carefully attaches the nerves, blood vessels, and tendons of the harvested toe to the thumb stump.
8. The provider verifies the connections to ensure the success of the flap and fashions it over the iliac bone graft.
9. Finally, the provider sutures the donor bone from the great toe to the iliac bone graft using K wire, closes the wound, and covers it with a sponge bandage.

4. Qualifying circumstances

CPT 26551 is performed for patients who have no thumb due to trauma or a congenital absence. The procedure is complex and typically requires two surgical teams working simultaneously. The provider transfers the great toe to replace the missing thumb, utilizing microvascular anastomosis and a bone graft. The patient must meet the specific criteria for this procedure, and the provider must carefully assess the patient’s condition and determine the appropriateness of the transfer.

5. When to use CPT code 26551

CPT code 26551 should be used when the provider performs the transfer of the great toe to the hand with microvascular anastomosis, specifically for patients who are missing a thumb. This code is not appropriate for other types of toe-to-hand transfers or for transfers involving toes other than the great toe.

6. Documentation requirements

To support a claim for CPT 26551, the provider must document the following information:

• Patient’s condition and the need for the thumb transfer
• Details of the procedure, including the use of microvascular anastomosis and a bone graft
• Date and duration of the procedure
• Specific techniques used during the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 26551, ensure that the procedure meets the specific criteria for the transfer of the great toe to the hand with microvascular anastomosis. It is important to accurately document the details of the procedure and any additional services provided. Report CPT 26551 as a single code without any modifiers. It is also important to follow any specific billing guidelines provided by insurance carriers or payers.

8. Historical information

CPT 26551 was added to the Current Procedural Terminology system on January 1, 1997. It was initially removed from the Inpatient Only (IPO) list in 2017 but was later added back to the list in 2022.

9. Examples

1. A patient who lost their thumb in a traumatic accident undergoes a transfer of the great toe to the hand with microvascular anastomosis to reconstruct the thumb.
2. A patient with a congenital absence of the thumb undergoes a transfer of the great toe to the hand with microvascular anastomosis to create a functional thumb.
3. A provider performs a transfer of the great toe to the hand with microvascular anastomosis for a patient who was born without a thumb.
4. A patient who lost their thumb due to a severe injury undergoes a transfer of the great toe to the hand with microvascular anastomosis to restore thumb function.
5. A provider performs a transfer of the great toe to the hand with microvascular anastomosis for a patient with a thumb deformity that affects hand function.
6. A patient with a thumb amputation undergoes a transfer of the great toe to the hand with microvascular anastomosis to improve hand dexterity.
7. A provider performs a transfer of the great toe to the hand with microvascular anastomosis for a patient with a thumb deficiency that impacts their ability to perform daily activities.
8. A patient who lost their thumb in a work-related accident undergoes a transfer of the great toe to the hand with microvascular anastomosis to restore hand function.