How To Use CPT Code 26686

CPT 26686 describes the open treatment of carpometacarpal dislocation, other than thumb, that involves complex, multiple, or delayed reduction. 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 26686?

CPT 26686 can be used to describe the open treatment of carpometacarpal dislocation, excluding the thumb, that requires complex, multiple, or delayed reduction. This code is used when the provider repairs displaced bones in the joint where the wrist joins the hand, in cases that are complicated by complex dislocations, multiple dislocations, or a delay between the time of the injury and the surgical repair.

2. Official Description

The official description of CPT code 26686 is: ‘Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduction.’

3. Procedure

1. The provider prepares and anesthetizes the patient.
2. An incision is made over the dislocated joint.
3. The provider performs a complicated reduction of the dislocated bones, which may involve excision of adhesions or multiple reductions.
4. The alignment is confirmed with imaging.
5. The area is irrigated, checked for bleeding, and any instruments are removed.
6. The incision is closed, and a splint or brace is applied.

4. Qualifying circumstances

CPT 26686 is used for cases where the open treatment of carpometacarpal dislocation, other than thumb, requires complex, multiple, or delayed reduction. This code is applicable when there are complications such as complex dislocations, multiple dislocations, or a delay between the time of the injury and the surgical repair.

5. When to use CPT code 26686

CPT code 26686 should be used when the open treatment of carpometacarpal dislocation, other than thumb, involves complex, multiple, or delayed reduction. It should not be used for other types of dislocations or reductions.

6. Documentation requirements

To support a claim for CPT 26686, the provider must document the following information:

• Patient’s diagnosis and the need for open treatment of carpometacarpal dislocation
• Details of the procedure, including the complexity, multiple dislocations, or delayed reduction
• Date of the procedure
• Incision site and size
• Confirmation of alignment with imaging
• Any complications encountered during the procedure
• Post-operative care instructions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26686, ensure that the procedure meets the criteria for complex, multiple, or delayed reduction of carpometacarpal dislocation, other than thumb. It is important to document the complexity, multiple dislocations, or delayed reduction in the medical record to support the use of this code. 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 ensure that the diagnosis code aligns with the procedure performed.

8. Historical information

CPT 26686 was added to the Current Procedural Terminology system on January 1, 1990. There have been two code changes since its addition, with the most recent change occurring on January 1, 2008.

9. Examples

1. A provider performs an open treatment of a complex carpometacarpal dislocation in a patient who sustained multiple injuries in a car accident.
2. A surgeon performs an open reduction of a delayed carpometacarpal dislocation in a patient who had initially sought treatment for a different injury.
3. A hand specialist performs an open treatment of a carpometacarpal dislocation with multiple dislocations in a patient who had a history of joint instability.
4. A provider performs an open treatment of a complex carpometacarpal dislocation in a patient who had delayed seeking medical attention due to fear of surgery.
5. A surgeon performs an open reduction of a carpometacarpal dislocation with multiple dislocations in a patient who sustained a sports-related injury.
6. A hand specialist performs an open treatment of a delayed carpometacarpal dislocation in a patient who had previously undergone unsuccessful conservative treatment.
7. A provider performs an open treatment of a complex carpometacarpal dislocation in a patient who had a history of joint hypermobility.
8. A surgeon performs an open reduction of a carpometacarpal dislocation with multiple dislocations in a patient who sustained a workplace injury.
9. A hand specialist performs an open treatment of a delayed carpometacarpal dislocation in a patient who had delayed seeking medical attention due to financial constraints.
10. A provider performs an open treatment of a complex carpometacarpal dislocation in a patient who had a history of recurrent dislocations.