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The procedure described by CPT® Code 26434 involves the surgical repair of the extensor tendon at its distal insertion, utilizing a free graft. This type of injury often results in a condition known as mallet finger, characterized by the inability to straighten the affected finger due to a flexion deformity at the distal interphalangeal joint. Such injuries typically occur from a blunt force impact to the fingertip, leading to a tear or rupture of the tendon. In some instances, the injury may also involve a fragment of bone being avulsed along with the tendon. The timing of the repair is critical; primary repairs are generally conducted within 24 hours post-injury, while secondary repairs are indicated for cases where the repair is performed more than two weeks after the injury, particularly if there is significant contamination of the wound. The surgical approach involves making 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 ruptured tendon, which may necessitate an additional incision. In cases where a bone fragment is involved, it may be secured to the distal phalanx using pins or screws. The unique aspect of CPT® Code 26434 is the use of a free graft, which is harvested from either the forearm or leg, and is then sutured to the proximal end of the ruptured tendon, with the distal end secured to the tendon or the distal phalanx, ensuring proper alignment and function post-repair.
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The procedure described by CPT® Code 26434 is indicated for the repair of injuries to the distal insertion of the extensor tendon, particularly in cases where there is a significant rupture or tear that may lead to mallet finger. The following conditions warrant this surgical intervention:
The surgical procedure for CPT® Code 26434 involves several critical steps to ensure effective repair of the extensor tendon. The following outlines the procedural steps:
After the completion of the procedure, post-operative care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or improper healing. Rehabilitation may involve physical therapy to restore range of motion and strength in the affected finger. The expected recovery time can vary based on the extent of the injury and the individual’s healing response. Follow-up appointments are necessary to assess the healing process and to determine when the patient can safely resume normal activities.
| Short Descr | REPAIR/GRAFT FINGER TENDON | Medium Descr | REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT | Long Descr | Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft) | 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 |
| 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.) | 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 | 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) |
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