How To Use CPT Code 26746

CPT 26746 describes the open treatment of an articular fracture involving a metacarpophalangeal or interphalangeal joint, including internal fixation if performed. 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 26746?

CPT 26746 can be used to describe the open treatment of an articular fracture involving a metacarpophalangeal or interphalangeal joint. This code includes the use of internal fixation implants, such as pins, wires, or screws, if performed by the provider. It is important to note that this code is specific to fractures in the hand and fingers.

2. Official Description

The official description of CPT code 26746 is: ‘Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each.’

3. Procedure

1. The provider begins by confirming the presence of an articular fracture in the metacarpophalangeal or interphalangeal joint using X-rays.
2. After the patient is appropriately prepped and anesthetized, the provider makes an incision over the fractured bone.
3. They then dissect through the subcutaneous tissue, taking care to protect the nerves and vessels.
4. The provider retracts the muscles to gain adequate exposure of the fracture.
5. Next, they realign the fractured fragments, performing manipulation if necessary.
6. The provider then uses internal fixation implants, such as screws, nails, or wires, to stabilize the fracture.
7. Finally, they close the wound by suturing the skin layers together and place the patient’s joint in a brace or splint for approximately four weeks.

4. Qualifying circumstances

CPT 26746 is used for the open treatment of an articular fracture involving a metacarpophalangeal or interphalangeal joint. The procedure may include the use of internal fixation implants, such as pins, wires, or screws, to stabilize the fracture. It is important to note that this code is specific to fractures in the hand and fingers.

5. When to use CPT code 26746

CPT code 26746 should be used when the provider performs an open treatment of an articular fracture involving a metacarpophalangeal or interphalangeal joint, including the use of internal fixation implants if necessary. This code should not be used for closed treatments or treatments involving other joints in the body.

6. Documentation requirements

To support a claim for CPT 26746, the provider must document the following information:

• Confirmation of the articular fracture through X-ray examination
• Description of the specific metacarpophalangeal or interphalangeal joint involved
• Details of the procedure, including the incision, dissection, realignment, and use of internal fixation implants
• Documentation of any manipulation performed to align the fractured fragments
• Information on the closure of the wound and the use of a brace or splint
• Any separately reportable X-ray examinations performed to confirm the reduction of the fracture

7. Billing guidelines

When billing for CPT 26746, ensure that the procedure involves the open treatment of an articular fracture in a metacarpophalangeal or interphalangeal joint, including the use of internal fixation implants if necessary. It is important to use this code only for fractures in the hand and fingers. Additionally, consider the use of other codes for closed treatments or treatments involving different joints in the body. It is also important to follow any specific guidelines provided by payers regarding the use of this code.

8. Historical information

CPT 26746 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, the code description was updated to include the option of internal or external fixation.

9. Examples

1. A patient presents with an articular fracture in their metacarpophalangeal joint. The provider performs an open treatment, realigning the fractured fragments and using screws for internal fixation.
2. During a basketball game, a player sustains an articular fracture in their interphalangeal joint. The provider performs an open treatment, utilizing wires for internal fixation to stabilize the fracture.
3. A patient is involved in a car accident and fractures their metacarpophalangeal joint. The provider performs an open treatment, using pins for internal fixation to ensure proper alignment of the fractured fragments.
4. An individual falls and fractures their interphalangeal joint. The provider performs an open treatment, utilizing screws for internal fixation to stabilize the fracture and promote healing.
5. A patient presents with an articular fracture in their metacarpophalangeal joint. The provider performs an open treatment, realigning the fractured fragments and using a combination of screws and wires for internal fixation.
6. During a sports activity, a player sustains an articular fracture in their interphalangeal joint. The provider performs an open treatment, utilizing screws and pins for internal fixation to stabilize the fracture and facilitate healing.
7. A patient is involved in a workplace accident and fractures their metacarpophalangeal joint. The provider performs an open treatment, using wires and screws for internal fixation to ensure proper alignment and stability of the fractured fragments.