How To Use CPT Code 26560

CPT 26560 describes the repair of syndactyly, also known as webbed fingers, by separating the congenitally joined fingers and using skin flaps to repair the incision. 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 26560?

CPT 26560 is used to describe the repair of syndactyly, a condition where two or more fingers are fused together by a web of tissue. The procedure involves separating the joined fingers by making a zigzag incision on the webbed skin and using skin flaps to repair the incision. This code represents the separation of a single web between two digits, and each web space is considered a unit.

2. Official Description

The official description of CPT code 26560 is: ‘Repair of syndactyly (web finger) each web space; with skin flaps.’

3. Procedure

1. The provider applies a tourniquet to restrict blood flow and makes a zigzag incision on the webbed skin between the joined fingers.
2. The incision is extended to the end of the webbing to completely release the fingers from each other.
3. The provider uses the flaps of skin left from the webbing to repair the operative site, ensuring the maintenance of vascularization to the flaps.
4. A layered closure is performed using absorbable sutures.
5. Antibiotic ointment and a nonabsorbent bulky sterile dressing are applied over the hand, with cotton fluffs between the fingers.
6. An above-elbow splint or cast may be applied to immobilize and protect the hand.

4. Qualifying circumstances

CPT 26560 is performed on patients with syndactyly, a congenital condition where the fingers are fused together by a web of tissue. The surgery is medically necessary when the condition causes functional impairment. Some carriers may require preauthorization and proof of medical necessity before covering the procedure. If the condition is purely cosmetic, it may not be covered by insurance.

5. When to use CPT code 26560

CPT code 26560 should be used when the provider performs the repair of syndactyly by separating the webbed fingers and using skin flaps for closure. This code represents the separation of a single web between two digits. If multiple webs are divided at the same setting, each web separation can be reported with the appropriate modifiers to identify them as separate procedures.

6. Documentation requirements

To support a claim for CPT 26560, the provider must document the following information:

• Patient’s diagnosis of syndactyly
• Details of the procedure performed, including the specific web space(s) involved
• Date of the procedure
• Method of repair, such as the use of skin flaps
• Any additional procedures performed, with appropriate modifiers if applicable
• Signature of the provider

7. Billing guidelines

When billing for CPT 26560, ensure that the procedure involves the repair of syndactyly with skin flaps. If both skin flaps and grafts are used in the repair, report CPT code 26561. If the repair involves bone and/or nails, report CPT code 26562. It is important to follow the payer’s guidelines regarding modifiers, such as modifier 50 for bilateral procedures. Some payers may require the procedure code to be reported twice, once with modifier LT for the left side and once with modifier RT for the right side.

8. Historical information

CPT code 26560 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs the repair of syndactyly on a patient with fused fingers in the web space between the index and middle finger.
2. A child with webbed fingers undergoes surgery to separate the fused digits using skin flaps.
3. A patient with syndactyly in the web space between the ring and little finger undergoes a procedure to release the fingers and repair the incision with skin flaps.
4. A provider performs the repair of syndactyly on a patient with fused fingers in multiple web spaces, using appropriate modifiers to identify the additional procedures.
5. A teenager with webbed toes undergoes surgery to separate the fused digits, following the same principles as the repair of syndactyly in the hand.