How To Use CPT Code 26863

CPT 26863 describes the surgical procedure of arthrodesis, specifically for the interphalangeal joint of the finger. This article will provide an overview of the code, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes to CPT 26863.

1. What is CPT Code 26863?

CPT 26863 is a code used to describe a surgical procedure known as arthrodesis. This procedure involves the fusion of the interphalangeal joint of the finger, with or without the use of internal fixation. The goal of this procedure is to immobilize the joint and reduce pain caused by arthritis or other conditions affecting the joint.

2. Official Description

The official description of CPT code 26863 is: ‘Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), each additional joint (List separately in addition to code for primary procedure).’ This code is an add-on procedure and should be used in conjunction with CPT code 26862.

3. Procedure

1. To perform CPT 26863, the provider begins by making an incision in the skin over the interphalangeal joint of the finger.
2. They then dissect through the subcutaneous tissue, preserving the nerves and veins.
3. The provider continues by dissecting the joint capsule to expose the joint surfaces.
4. They remove the articular cartilage from the joint surface, leaving raw bone.
5. If necessary, the provider may use internal fixation devices such as pins, wires, or nails to fuse the joint.
6. A cancellous bone graft, typically obtained from the iliac crest, is then used to pack the fused joint.
7. The provider ensures hemostasis and closes the wound by suturing the soft tissue layers.
8. Finally, the digit is placed in a splint for four weeks to aid in the healing process.

4. Qualifying circumstances

CPT 26863 is performed on patients who experience pain and discomfort in the interphalangeal joint of the finger due to arthritis or other conditions. The procedure is intended to immobilize the joint and alleviate the symptoms. It may involve the use of internal fixation devices and the use of an autograft obtained from another part of the patient’s body.

5. When to use CPT code 26863

CPT code 26863 should be used when a provider performs arthrodesis of an additional interphalangeal joint following the initial arthrodesis of another interphalangeal joint during the same surgical session. It is important to note that this code should only be reported in conjunction with the primary procedure code, CPT code 26862.

6. Documentation requirements

Documentation for CPT code 26863 should include the following:

• The need for arthrodesis and the specific joint being fused
• Details of the procedure, including the use of internal fixation devices and the source of the autograft
• Date of the procedure and the duration of the surgery
• Any complications or additional procedures performed
• Post-operative care instructions
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 26863, it is important to ensure that the procedure is performed in conjunction with the primary procedure code, CPT code 26862. Payers may not reimburse for CPT code 26863 if it is reported without the appropriate primary code. Additionally, it is important to follow any specific billing guidelines provided by the payer to ensure accurate reimbursement.

8. Historical information

CPT code 26863 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 patient undergoes arthrodesis of the interphalangeal joint of their index finger, followed by arthrodesis of the interphalangeal joint of their middle finger during the same surgical session.
2. After arthrodesis of the interphalangeal joint of the thumb, the provider performs arthrodesis of the interphalangeal joint of the ring finger at the same time.
3. During a single surgical session, the provider performs arthrodesis of the interphalangeal joint of the little finger, followed by arthrodesis of the interphalangeal joint of the middle finger.
4. Following the initial arthrodesis of the interphalangeal joint of the thumb, the provider performs arthrodesis of the interphalangeal joint of the index finger during the same procedure.
5. A patient undergoes arthrodesis of the interphalangeal joint of their ring finger, followed by arthrodesis of the interphalangeal joint of their little finger in the same surgical session.