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Repair or advancement of the flexor tendon, specifically coded as CPT® Code 26352, refers to a surgical procedure aimed at addressing injuries to the flexor tendons in the hand that are not located within zone 2 of the digital flexor tendon sheath, commonly referred to as "no man's land." This procedure is particularly relevant for cases involving partial or complete lacerations, tears, or ruptures of the flexor tendons. The flexor tendons are categorized into zones based on their anatomical location, with zone 1 encompassing injuries distal to the insertion of the flexor digitorum superficialis (FDS) tendon, which primarily involves the profundus tendon. Zone 3 pertains to injuries occurring in the palm, extending from the distal carpal ligament to the distal palmar crease. The timing of the repair is crucial; primary repairs are ideally conducted within 24 hours of the injury, although in cases of significant wound contamination, this may be postponed for up to two weeks. Secondary repairs, as indicated by this code, are performed more than two weeks post-injury. The surgical approach typically involves exposing the tendon through a volar zigzag or lateral incision, with careful dissection of the surrounding soft tissues to protect vital neurovascular structures. The surgeon locates the distal and proximal ends of the severed tendon, which may necessitate an additional incision if the proximal end has retracted. In the context of CPT® Code 26352, the procedure involves a secondary repair utilizing a free graft, which includes the harvesting of a tendon graft—often the palmaris longus from the distal forearm. This graft is then meticulously attached to the affected flexor muscle, usually at the wrist, and tunneled to the appropriate site for secure attachment, ensuring proper healing and function of the tendon.
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The procedure coded as CPT® Code 26352 is indicated for specific conditions related to flexor tendon injuries that necessitate surgical intervention. The following are the explicit indications for performing this procedure:
The procedure for CPT® Code 26352 involves several critical steps to ensure effective repair of the flexor tendon using a free graft. The following outlines the procedural steps:
After the completion of the procedure coded as CPT® Code 26352, post-operative care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or graft failure. Rehabilitation may be initiated based on the surgeon's recommendations, which often includes physical therapy to restore range of motion and strength in the affected hand. The recovery process may vary depending on the extent of the injury and the individual patient's healing response. Follow-up appointments are crucial to assess the healing of the tendon and the success of the graft integration.
| Short Descr | REPAIR/GRAFT HAND TENDON | Medium Descr | RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON | Long Descr | Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); secondary with free graft (includes obtaining graft), each tendon | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 2 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | F9 | Right hand, fifth digit | FA | Left hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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