How To Use CPT Code 26556

CPT 26556 describes the transfer of the free toe joint to replace a finger joint in patients who have lost finger joint function due to trauma or congenital deformity. 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 26556?

CPT 26556 can be used to describe the transfer of the free toe joint to replace a finger joint in patients who have lost finger joint function due to trauma or congenital deformity. This procedure involves removing the toe from the foot, including all 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 26556 is: ‘Transfer, free toe joint, with microvascular anastomosis.’

3. Procedure

1. In this complex procedure, the provider transfers the toe joint to replace the finger joint of the hand.
2. Usually, two surgical teams work together to complete the entire procedure.
3. One team harvests the toe, while the other team prepares the hand by excising the involved finger joint.
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. She dissects down through the subcutaneous tissue just under the skin and carefully incises the dorsalis pedis artery and first dorsal metatarsal artery.
6. Next, she makes an incision underneath the toe and isolates the digital nerves.
7. Using a surgical instrument, she separates the flap and dissects the entire toe down through the interphalangeal or metacarpophalangeal joint.
8. Using microsurgical techniques, the provider preserves the blood vessels and nerves with the flap for transfer.
9. She then closes the donor site wound with the help of a skin graft and covers it with a sterile bandage.
10. At the same surgical procedure, the provider obtains an iliac bone graft and uses it for fixation of the toe joint to the hand.
11. The provider attaches the toe to the finger stump on the hand using the operating microscope and microsurgical techniques.
12. She carefully attaches the nerves, blood vessels, and tendons of the harvested toe to the stump on the hand.
13. She verifies the connections to ensure that the flap does not fail.
14. Finally, she sutures the donor bone from the toe to the stump of the finger using K wire and closes the wound.

4. Qualifying circumstances

CPT 26556 is performed on patients who have lost finger joint function due to trauma or congenital deformity. The procedure involves transferring the free toe joint to replace the finger joint in the hand. It is important to note that code 69990 should not be reported in addition to code 26556, and for great toe-to-hand transfer, code 20973 should be used instead.

5. When to use CPT code 26556

CPT code 26556 should be used when a provider performs the transfer of the free toe joint to replace a finger joint in patients who have lost finger joint function due to trauma or congenital deformity. It is important to follow the specific documentation and coding guidelines for this procedure.

6. Documentation requirements

To support a claim for CPT 26556, the provider must document the following information:

• Patient’s diagnosis indicating the loss of finger joint function due to trauma or congenital deformity
• Details of the procedure, including the transfer of the free toe joint, use of microvascular anastomosis, and any bone grafts
• Date of the procedure
• Specific anatomical locations involved
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26556, ensure that the procedure meets the specific criteria outlined in the code description. It is important to follow the appropriate coding guidelines and not report code 69990 in addition to code 26556. Additionally, for great toe-to-hand transfer, use code 20973. Consider any specific billing requirements from payers and ensure accurate and complete documentation to support the claim.

8. Historical information

CPT 26556 was added to the Current Procedural Terminology system on January 1, 1997. There have been several historical changes to the code, including being added and removed from the Inpatient Only (IPO) list for Medicare. It is important to stay updated on any changes or updates to the code.

9. Examples

1. A patient who lost finger joint function due to trauma undergoes a transfer of the free toe joint to replace the finger joint in the hand.
2. A patient with a congenital deformity receives a transfer of the free toe joint to replace the finger joint in the hand.
3. A provider performs a transfer of the free toe joint to replace the finger joint in a patient who has lost finger joint function due to trauma.
4. A patient with a congenital deformity undergoes a transfer of the free toe joint to replace the finger joint in the hand.
5. A provider performs a transfer of the free toe joint to replace the finger joint in a patient who has lost finger joint function due to trauma.
6. A patient with a congenital deformity receives a transfer of the free toe joint to replace the finger joint in the hand.