How To Use CPT Code 26650

CPT 26650 describes the percutaneous skeletal fixation of a carpometacarpal fracture dislocation in the thumb, specifically known as a Bennett fracture, with manipulation. 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 26650?

CPT 26650 is used to describe a specific procedure called percutaneous skeletal fixation, which involves the manipulation and stabilization of a Bennett fracture in the thumb. This procedure is performed by inserting wires or pins directly through the skin into the bones of the carpometacarpal joint to restore normal alignment and facilitate healing.

2. Official Description

The official description of CPT code 26650 is: ‘Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation.’

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. Next, the provider manipulates the bones of the carpometacarpal joint at the base of the thumb, also known as the basal thumb joint, into the correct anatomical position.
3. Using fluoroscopic guidance, the provider drills one or more wires through the skin and into the bones to maintain the alignment.
4. Finally, the provider dresses the wound to ensure proper healing.

4. Qualifying circumstances

CPT 26650 is performed on patients with a specific type of fracture known as a Bennett fracture, which involves a dislocation at the carpometacarpal joint in the thumb. This procedure is appropriate when the bones are displaced and require manipulation and stabilization. It is important to note that this procedure should only be performed by a qualified healthcare professional.

5. When to use CPT code 26650

CPT code 26650 should be used when a provider performs percutaneous skeletal fixation for a Bennett fracture in the thumb. It is important to ensure that the procedure involves manipulation and the use of wires or pins to stabilize the bones. If the procedure does not meet these criteria, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 26650, the provider must document the following information:

• Diagnosis of a Bennett fracture and the need for percutaneous skeletal fixation
• Details of the procedure, including the manipulation of the bones and the insertion of wires or pins
• Date of the procedure
• Any additional services or procedures performed during the same encounter
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 26650, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, it is important to follow any specific billing guidelines provided by the payer. Modifier 57, Decision for surgery, may be used if an evaluation and management service was performed prior to the decision for surgery. It is also important to note that fluoroscopic guidance is generally not reported separately for this procedure.

8. Historical information

CPT code 26650 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs percutaneous skeletal fixation with manipulation for a Bennett fracture in the thumb.
2. During the procedure, the provider manipulates the bones of the carpometacarpal joint and inserts wires to stabilize the fracture.
3. The patient’s diagnosis and the need for the procedure are documented, along with the details of the manipulation and fixation.
4. The provider signs the documentation to support the claim for CPT code 26650.
5. Another provider performs open treatment with internal fixation for a Bennett fracture in the thumb.
6. The procedure involves surgically accessing the fracture site and using internal hardware to stabilize the bones.
7. The documentation includes the diagnosis, details of the procedure, and the provider’s signature.
8. A different patient undergoes closed treatment with manipulation for a Bennett fracture in the thumb.
9. The provider manually manipulates the bones to restore alignment and facilitate healing.
10. The documentation includes the diagnosis, details of the manipulation, and the provider’s signature.