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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, including the transfer of tendons such as the palmaris longus, flexor digiti superficialis, extensor indicis, extensor digiti minimi, and flexor pollicis brevis, among others. Each technique is designed to re-establish the necessary muscle function to enable thumb movement. Specifically, CPT® Code 26492 refers to the method where a tendon graft is harvested from either the forearm or leg and then transplanted to the muscles and tendons of the palm and thumb. This grafting process is essential for restoring the abduction of the thumb, which is vital for hand functionality. The procedure may also involve the transfer of the flexor carpi ulnaris tendon, which is extended with the tendon graft to enhance the effectiveness of the surgical intervention. Overall, opponensplasty is a critical procedure for patients suffering from thumb abduction issues due to median nerve injuries, aiming to improve their quality of life and hand function.
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The procedure of opponensplasty, specifically CPT® Code 26492, 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 essential for grasping and pinching. The indications for this procedure include:
The procedure for CPT® Code 26492 involves several detailed steps to ensure successful tendon transfer and restoration of thumb abduction. The following procedural steps are outlined:
Post-procedure care following CPT® Code 26492 is essential for optimal recovery and includes monitoring for any complications, managing pain, and ensuring proper healing of the surgical site. Patients are typically advised to keep the thumb immobilized in opposition using a splint to protect the newly placed tendon graft. Rehabilitation may involve physical therapy to regain strength and mobility in the thumb, with a focus on gradually increasing the range of motion and functionality. Follow-up appointments are necessary to assess the healing process and the effectiveness of the procedure in restoring thumb abduction.
| Short Descr | TENDON TRANSFER WITH GRAFT | Medium Descr | OPPONENSPLASTY TDN TR W/GRF EA TDN | Long Descr | Opponensplasty; tendon transfer with 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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. | 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 | F3 | Left hand, fourth digit | F8 | Right hand, fourth digit | FA | Left hand, thumb | 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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