How To Use CPT Code 26553

CPT 26553 describes the procedure for transferring a toe to the hand with microvascular anastomosis, specifically for digits other than the great toe. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26553?

CPT 26553 is used to describe the surgical procedure in which a toe is transferred to the hand with microvascular anastomosis. This procedure is performed when a patient is missing a thumb or finger due to trauma or a congenital absence of the digit. The provider removes a toe, along with its related blood vessels, nerves, bones, and tendons, from the foot and transplants it to the hand to reconstruct a thumb or finger.

2. Official Description

The official description of CPT code 26553 is: ‘Transfer, toe-to-hand with microvascular anastomosis; other than great toe, single.’

3. Procedure

1. In this complex procedure, the provider transfers a toe to replace a missing thumb or finger on the hand.
2. Two surgical teams typically work together simultaneously to complete the entire procedure.
3. One team harvests the toe, while the other team prepares the stump of the thumb or finger on the hand to accept the graft.
4. The provider makes a circular incision on the dorsal surface of the toe to create flaps on the inner and outer side of the toe.
5. He dissects down through the subcutaneous tissue and carefully incises the dorsalis pedis artery and first dorsal metatarsal artery.
6. Next, he makes an incision on the underneath of the toe and isolates the digital nerves.
7. 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.
8. The provider closes the donor site wound with the help of a skin graft and covers it with a sterile bandage.
9. At the same surgical procedure, the other surgical team attaches the toe to the thumb or finger stump using microsurgical techniques.
10. The provider carefully attaches the nerves, blood vessels, and tendons of the harvested toe to the thumb or finger stump.
11. He verifies the connections to ensure the success of the flap.
12. The provider fashions the flap over the thumb or finger stump and sutures the donor bone from the toe to the stump using K wire.
13. Finally, he closes the wound, covers it with a loose sponge bandage, and may place a drain if necessary.

4. Qualifying circumstances

CPT 26553 is performed on patients who have no thumb or finger due to trauma or a congenital absence of the digit. The procedure is intended to reconstruct a thumb or finger using a toe from the foot. It is important to note that this procedure is specific to digits other than the great toe.

5. When to use CPT code 26553

CPT code 26553 should be used when a provider performs the transfer of a toe to the hand with microvascular anastomosis for digits other than the great toe. It is important to accurately document the specific digit involved in the procedure.

6. Documentation requirements

To support a claim for CPT 26553, the provider must document the following information:

• Patient’s condition necessitating the toe-to-hand transfer
• Specific digit involved in the procedure
• Date of the procedure
• Details of the surgical technique used
• Specific blood vessels, nerves, bones, and tendons involved in the transfer
• Any additional procedures performed during the same surgical session
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 26553, ensure that the procedure involves the transfer of a toe to the hand with microvascular anastomosis for digits other than the great toe. It is important to follow the specific documentation requirements and accurately report the details of the procedure. Additionally, be aware of any specific guidelines or modifiers that may apply when reporting this code.

8. Historical information

CPT 26553 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 index finger due to trauma undergoes a toe-to-hand transfer procedure to reconstruct the missing digit.
2. A congenital absence of the little finger prompts a patient to undergo a toe-to-hand transfer procedure for digit reconstruction.
3. A patient with a thumb amputation receives a toe-to-hand transfer procedure to restore thumb functionality.
4. A patient born without a middle finger undergoes a toe-to-hand transfer procedure to reconstruct the missing digit.
5. A patient with a traumatic loss of the ring finger undergoes a toe-to-hand transfer procedure for digit reconstruction.
6. A patient with a thumb deformity due to a congenital condition receives a toe-to-hand transfer procedure to improve hand function.
7. A patient with a traumatic loss of the pinky finger undergoes a toe-to-hand transfer procedure for digit reconstruction.
8. A patient with a thumb amputation due to an industrial accident undergoes a toe-to-hand transfer procedure to restore thumb functionality.
9. A patient with a congenital absence of the index finger receives a toe-to-hand transfer procedure for digit reconstruction.
10. A patient with a traumatic loss of the middle finger undergoes a toe-to-hand transfer procedure to reconstruct the missing digit.