How To Use CPT Code 26554

CPT 26554 describes the transfer of toes to the hand with microvascular anastomosis, specifically for digits other than the great toe. 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 26554?

CPT 26554 can be used to describe a surgical procedure in which the provider transfers toes from the foot to the hand to reconstruct missing digits, excluding the thumb. This transfer involves the use of microvascular anastomosis, which involves connecting very small blood vessels under an operating microscope. The procedure is typically performed when a patient has experienced trauma or has a congenital absence of the digits.

2. Official Description

The official description of CPT code 26554 is: ‘Transfer, toe-to-hand with microvascular anastomosis; other than great toe, double.’ This code specifically refers to the transfer of toes other than the great toe to the hand, with the use of microvascular anastomosis.

3. Procedure

1. In this complex procedure, the provider transfers toes from the foot to replace missing digits on the hand.
2. The surgical teams work simultaneously, with one team harvesting the toes and the other team preparing the stumps on the hand to accept the grafts.
3. 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.
4. She dissects down through the subcutaneous tissue and carefully incises the dorsalis pedis artery and first dorsal metatarsal artery.
5. Next, she makes an incision on the underneath of the toe and isolates the digital nerves.
6. 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.
7. The provider closes the donor site wound with the help of a skin graft and covers it with a sterile bandage.
8. At the same time, the other surgical team attaches the harvested toes to the stumps on the hand, using microsurgical techniques to carefully connect the nerves, blood vessels, and tendons.
9. The provider verifies the connections to ensure the success of the flaps and sutures the donor bone from the toe to the stumps using K wire.
10. Finally, the wounds are closed, covered with loose sponge bandages, and a drain may be placed if necessary.

4. Qualifying circumstances

CPT 26554 is performed on patients who have no thumb or finger due to trauma or a congenital absence of the digits. The procedure is typically reserved for complex cases where the transfer of toes from the foot to the hand is necessary. It is important to note that CPT code 26554 specifically refers to the transfer of digits other than the great toe.

5. When to use CPT code 26554

CPT code 26554 should be used when a provider performs the transfer of toes to the hand with microvascular anastomosis for digits other than the great toe. It is important to accurately document the specific details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 26554, the provider must document the following information:

• Patient’s condition and the need for the toe-to-hand transfer
• Details of the procedure, including the specific toes used and the use of microvascular anastomosis
• Date of the procedure
• Specific steps taken during the procedure, including the harvesting of the toes, preparation of the hand stumps, and the attachment of the toes to the hand
• Any additional procedures performed during the same surgical session
• Signature of the provider

7. Billing guidelines

When billing for CPT 26554, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure to support the use of this code. Additionally, be aware of any specific billing guidelines or modifiers that may be required by payers.

8. Historical information

CPT 26554 was added to the Current Procedural Terminology system on January 1, 1997. There have been several historical changes to the code, including its addition and removal from the Inpatient Only (IPO) list for Medicare. It is important to stay updated on any changes or updates to ensure accurate billing and coding.

9. Examples

1. A patient who has lost multiple digits on their hand due to trauma undergoes a toe-to-hand transfer procedure using toes other than the great toe.
2. A congenital absence of fingers in a patient leads to the need for a toe-to-hand transfer procedure using toes other than the great toe.
3. A patient with a severe hand injury requires a toe-to-hand transfer procedure to reconstruct missing digits other than the great toe.
4. A patient born with a congenital condition that resulted in the absence of fingers undergoes a toe-to-hand transfer procedure using toes other than the great toe.
5. A patient who experienced a traumatic accident resulting in the loss of multiple digits on their hand undergoes a toe-to-hand transfer procedure using toes other than the great toe.
6. A patient with a complex hand injury requires a toe-to-hand transfer procedure to reconstruct missing digits other than the great toe.