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The procedure described by CPT® Code 26358 involves the repair or advancement of a flexor tendon located in zone 2 of the digital flexor tendon sheath, commonly referred to as "no man's land." This area is critical for hand function and is defined anatomically as the region between the insertion of the flexor digitorum superficialis tendon and the proximal A1 pulley, extending from the proximal end of the proximal phalanx to the distal end of the middle phalanx. Injuries to the flexor tendons can manifest as partial or complete lacerations, tears, or ruptures, necessitating surgical intervention for proper healing and restoration of function. The procedure is categorized as a secondary repair, which is typically performed more than two weeks after the initial injury, especially when primary repair is not feasible due to factors such as gross contamination of the wound. During the surgical process, the tendon is accessed through a volar zigzag or lateral incision, with careful dissection of soft tissues to protect surrounding neurovascular structures. The surgeon locates the distal and proximal ends of the severed tendon, which may require additional incisions if the proximal end has retracted. In this specific procedure, a free graft is utilized, which involves harvesting a tendon graft—often the palmaris longus from the distal forearm—and securing it to the affected flexor muscle at the wrist, then tunneling it to the appropriate attachment point. This method is essential for restoring the continuity and function of the flexor tendon in the hand.
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The procedure described by CPT® Code 26358 is indicated for the repair of flexor tendon injuries specifically in zone 2 of the digital flexor tendon sheath. The following conditions may warrant this surgical intervention:
The procedure for CPT® Code 26358 involves several critical steps to ensure effective repair of the flexor tendon using a free graft. The following procedural steps are outlined:
After the completion of the procedure, post-operative care is essential for optimal recovery. Patients may be advised to follow specific rehabilitation protocols to regain strength and mobility in the affected hand. This may include physical therapy to facilitate tendon gliding and prevent adhesions. The surgeon will monitor the healing process and may schedule follow-up appointments to assess the repair's success and adjust rehabilitation as necessary. Patients should also be informed about signs of complications, such as increased pain, swelling, or signs of infection, and instructed to seek medical attention if these occur.
| Short Descr | REPAIR/GRAFT HAND TENDON | Medium Descr | RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON | Long Descr | Repair or advancement, flexor tendon, 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) | 0 - Co-surgeons not permitted for this procedure. | 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.) | 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) |
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| 2004-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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