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Opponensplasty is a surgical procedure aimed at restoring thumb abduction, particularly in patients who have experienced median nerve damage. This condition often results in a loss of function in the thumb, which is critical for grasping and pinching movements. The procedure involves various techniques, one of which is the transfer of the superficialis tendon, as described in CPT® Code 26490. During this operation, a pulley system is created using slips from the flexor carpi ulnaris and extensor carpi ulnaris tendons to facilitate the movement of the transferred tendon. The surgery typically requires an incision on the ulnar side of the wrist, where the flexor carpi ulnaris tendon is carefully exposed, dissected, and split longitudinally. The medial slip of this tendon is then divided to create a functional pulley that allows the superficialis tendon to be effectively transferred and sutured to the appropriate structures in the hand. This technique is essential for restoring the ability to abduct the thumb, thereby improving hand function and quality of life for individuals affected by median nerve injuries.
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The procedure of opponensplasty, specifically the superficialis tendon transfer as described in CPT® Code 26490, is indicated for patients who have experienced median nerve damage leading to impaired thumb abduction. This condition may manifest as weakness or inability to perform tasks that require thumb opposition, which is crucial for effective grip and hand function. The surgery is typically considered when conservative treatments have failed to restore adequate function, and the patient demonstrates a need for surgical intervention to regain thumb mobility and strength.
The procedure for opponensplasty using the superficialis tendon transfer involves several detailed steps to ensure successful restoration of thumb abduction. Initially, an incision is made over the ulnar aspect of the wrist to access the flexor carpi ulnaris tendon. This tendon is then carefully exposed and dissected, followed by a longitudinal split to facilitate the creation of a pulley system. The medial slip of the flexor carpi ulnaris tendon is divided approximately 4 cm proximal to its insertion on the pisiform bone. Next, the insertion of the extensor carpi ulnaris tendon is exposed, and the proximal end of the divided slip of the flexor carpi ulnaris is sutured to the insertion of the extensor carpi ulnaris, forming a functional pulley. Subsequently, the tendon of the superficialis is divided and passed under the remaining portion of the flexor carpi ulnaris and through the newly created pulley. A subcutaneous tunnel is then created, allowing the two slips of the superficialis tendon to be pulled through. One slip is sutured to the distal part of the first metacarpal, while the other slip is attached to either the insertion of the abductor pollicis brevis or the proximal phalanx, effectively restoring thumb abduction.
After the completion of the opponensplasty procedure, patients typically require a period of immobilization to allow for proper healing and to maintain the position of the thumb. The thumb is usually immobilized in opposition using a splint to ensure that the newly sutured tendons are not subjected to undue stress during the initial recovery phase. Post-operative care may include pain management, monitoring for signs of infection, and follow-up appointments to assess healing and function. Rehabilitation exercises may be introduced gradually to restore mobility and strength in the thumb, with the goal of achieving optimal hand function.
| Short Descr | REVISE THUMB TENDON | Medium Descr | OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN | Long Descr | Opponensplasty; superficialis tendon transfer type, 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). | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F5 | Right hand, thumb | 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 |
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