How To Use CPT Code 26615

CPT 26615 describes the open treatment of a metacarpal fracture, which involves repairing a fractured metacarpal bone through an incision in the hand. 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 26615?

CPT 26615 is used to describe the open treatment of a metacarpal fracture. This procedure involves repairing a fractured metacarpal bone through an incision in the hand. The provider may also apply hardware, such as plates or screws, to hold the bone in place as it heals.

2. Official Description

The official description of CPT code 26615 is: ‘Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone.’

3. Procedure

1. The provider begins by making an incision over the site of the fracture in the hand.
2. She then reduces the fracture, which involves restoring the bone to its correct anatomical position.
3. If necessary, the provider may insert a metal plate or small wires to maintain the reduction.
4. The alignment of the bone is confirmed using imaging techniques.
5. The provider irrigates the area, checks for bleeding, removes any instruments, and closes the incision.
6. A splint or brace may be applied to support the healing process.

4. Qualifying circumstances

CPT 26615 is used for the open treatment of a metacarpal fracture. This procedure is performed when a patient has a fractured metacarpal bone that requires surgical intervention. The provider must make an incision in the hand and may use internal fixation, such as plates or screws, to stabilize the fracture.

5. When to use CPT code 26615

CPT code 26615 should be used when a provider performs the open treatment of a single metacarpal fracture and includes internal fixation, if performed. This code is appropriate when the procedure is performed on each individual bone.

6. Documentation requirements

To support a claim for CPT 26615, the provider must document the following information:

• The diagnosis of a metacarpal fracture
• The need for surgical intervention
• A description of the procedure performed, including the use of internal fixation
• The date of the procedure
• Any complications or additional procedures performed
• The provider’s signature

7. Billing guidelines

When billing for CPT 26615, ensure that the procedure meets the criteria for this code, including the open treatment of a metacarpal fracture with internal fixation. It is important to document the need for surgery and any additional services provided. Modifier 57, Decision for surgery, may be used if an evaluation and management service resulted in the decision for surgery. It is also important to use the appropriate diagnosis code that supports the need for the procedure.

8. Historical information

CPT 26615 was added to the Current Procedural Terminology system on January 1, 1990. The code was later revised on January 1, 2008 to include the option for internal or external fixation.

9. Examples

1. A patient sustains a fracture in their second metacarpal bone and undergoes open treatment with internal fixation.
2. A provider performs open treatment with internal fixation on a patient with a fractured fifth metacarpal bone.
3. An individual fractures their third metacarpal bone and requires open treatment with internal fixation.
4. A patient presents with a fractured first metacarpal bone and undergoes open treatment with internal fixation.
5. A provider performs open treatment with internal fixation on a patient with a fractured fourth metacarpal bone.
6. An individual sustains a fracture in their second metacarpal bone and requires open treatment with internal fixation.
7. A patient fractures their fifth metacarpal bone and undergoes open treatment with internal fixation.
8. A provider performs open treatment with internal fixation on a patient with a fractured third metacarpal bone.
9. An individual sustains a fracture in their first metacarpal bone and requires open treatment with internal fixation.
10. A patient presents with a fractured fourth metacarpal bone and undergoes open treatment with internal fixation.