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The procedure described by CPT® Code 26428 involves the repair of the extensor tendon, specifically the central slip, which is a critical component in the function of the fingers. The extensor tendons are responsible for straightening the fingers, and the central slip is the tendon that attaches to the middle phalanx, allowing for proper extension at the proximal interphalangeal joint. When the central slip is damaged, it can lead to a condition known as a boutonniere deformity, characterized by the inability to fully straighten the finger at this joint. This injury can occur due to various reasons, including a forceful impact to a bent finger, a laceration that severs the tendon, or conditions such as rheumatoid arthritis. The repair procedure classified under this code is considered a secondary repair, which is typically performed after a primary repair has failed or after a significant delay following the initial injury. The surgical approach involves making an incision over the affected area to expose the extensor tendon and central slip, allowing for the necessary repair techniques to be employed. In this case, a free graft is utilized, which involves harvesting a tendon from another site, such as the forearm or leg, to replace the damaged tendon. This method is essential for restoring the function of the finger and ensuring proper healing and alignment of the extensor mechanism.
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The procedure described by CPT® Code 26428 is indicated for the following conditions:
The procedure for repairing the extensor tendon and central slip involves several critical steps:
Post-procedure care following the repair of the extensor tendon and central slip is crucial for optimal recovery. Patients are typically advised to keep the finger immobilized to protect the surgical site and allow for healing. Follow-up appointments are necessary to monitor the healing process and to remove any sutures or pins as required. Rehabilitation may include physical therapy to restore range of motion and strength in the finger once the initial healing has occurred. Patients should 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 FINGER TENDON | Medium Descr | RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER | Long Descr | Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes obtaining graft), each finger | 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 | 2 | 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). | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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 | 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 | 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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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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