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The procedure described by CPT® Code 26489 involves the transfer or transplantation of a tendon located in the palm of the hand, specifically utilizing a free tendon graft. This surgical intervention is typically performed to restore functionality that may have been compromised due to traumatic injuries affecting the nerve, tendon, or muscle. In some cases, the loss of function may also arise from conditions such as rheumatoid arthritis or gouty arthritis. The complexity of the procedure can vary based on the specific function that the surgeon aims to restore, which necessitates a tailored approach to each individual case.
During the procedure, a longitudinal incision is made over the donor tendon to expose it adequately. The surgeon meticulously frees the donor tendon from its attachments, ensuring that it can be securely anchored to the recipient site. This process may involve harvesting the tendon along with a strip of periosteum to provide additional support. Furthermore, to maximize the mobility and length of the tendon transfer, the associated muscle may also be released from its fascial attachments. A second incision is then created at the recipient site, where the donor tendon will be affixed. The donor tendon is routed to this site and temporarily secured with sutures. A neuromuscular stimulator is employed to assess the functionality of the donor tendon, allowing for adjustments in tension to optimize performance before the tendon is permanently secured. After the surgical wounds are closed, immobilization of the wrist and/or hand is implemented as necessary to facilitate recovery.
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The procedure described by CPT® Code 26489 is indicated for the following conditions:
The procedure begins with the creation of a longitudinal incision over the donor tendon, which is the tendon that will be transferred or transplanted. This incision allows the surgeon to expose the tendon adequately. Once exposed, the surgeon carefully frees the donor tendon from its surrounding attachments, ensuring that it can be mobilized effectively for transfer. This may involve harvesting the tendon along with a strip of periosteum, which provides additional structural support during the transfer process.
To enhance the mobility and length of the tendon being transferred, the associated muscle may also be released from its fascial attachments. This step is crucial as it allows for greater flexibility and range of motion for the tendon once it is secured at the recipient site. Following the preparation of the donor tendon, a second incision is made over the recipient site, which is the area where the tendon will be attached to restore function.
After the recipient site is prepared, the donor tendon is routed to this location and temporarily secured using sutures. At this stage, a neuromuscular stimulator is utilized to test the function of the donor tendon, ensuring that it is capable of performing the necessary movements. The surgeon may adjust the tension of the donor tendon as needed to achieve optimal function before permanently securing it at the recipient site. Once the tendon is properly positioned and secured, the surgical wounds are closed, and the wrist and/or hand is immobilized as required to promote healing and recovery.
After the completion of the tendon transfer or transplantation procedure, post-operative care is essential for recovery. The wrist and/or hand will typically be immobilized to prevent movement that could disrupt the healing process. Patients may be monitored for any signs of complications, such as infection or improper healing. Rehabilitation and physical therapy may be recommended to restore function and strength in the hand as healing progresses. The duration of immobilization and the specifics of rehabilitation will depend on the individual case and the extent of the procedure performed.
| Short Descr | TRANSPLANT/GRAFT PALM TENDON | Medium Descr | TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH | Long Descr | Transfer or transplant of tendon, palmar; with free tendon 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 | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | F5 | Right hand, thumb | F8 | Right hand, fourth 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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