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The procedure described by CPT® Code 26412 involves the repair of an extensor tendon in the hand, utilizing a free graft. Extensor tendons are crucial for the extension of fingers and the wrist, and injuries to these tendons can result in significant functional impairment. Such injuries may manifest as partial or complete lacerations, tears, or ruptures, which can occur due to trauma or other mechanical forces. The timing of the repair is critical; primary repairs are ideally conducted within 24 hours of the injury to optimize healing and restore function. However, in cases where the wound is grossly contaminated, the primary repair may be postponed for up to two weeks to ensure a cleaner surgical field. Secondary repairs, on the other hand, are indicated when the surgical intervention occurs more than two weeks post-injury. The surgical approach typically involves a dorsal incision to expose the tendon, with careful dissection of 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 beyond reach. In the context of CPT® Code 26412, the procedure specifically entails the use of a free graft, which is harvested from either the forearm or leg. This graft is then meticulously attached to the affected extensor muscle and tunneled to the injury site, where it is secured with sutures, facilitating the restoration of tendon continuity and function.
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The procedure described by CPT® Code 26412 is indicated for the repair of extensor tendon injuries in the hand. The specific indications include:
The procedure for CPT® Code 26412 involves several critical steps to ensure effective repair of the extensor tendon using a free graft. The steps include:
Post-procedure care following the repair of the extensor tendon using a free graft is essential for optimal recovery. Patients are typically monitored for signs of infection and proper healing at the surgical site. Rehabilitation may include physical therapy to restore range of motion and strength in the affected hand. The recovery process can vary depending on the extent of the injury and the individual’s overall health, but it is crucial to follow the surgeon's guidelines regarding activity restrictions and follow-up appointments to ensure the best possible outcome.
| Short Descr | REPAIR/GRAFT HAND TENDON | Medium Descr | REPAIR EXTENSOR TENDON HAND W/GRAFT EACH | Long Descr | Repair, extensor tendon, hand, primary or 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) | 0 - Payment restriction for assistants at surgery applies 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 | 3 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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 | CR | Catastrophe/disaster related | 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) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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