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The procedure described by CPT® Code 26500 involves the reconstruction of a tendon pulley using local tissues, classified as a separate procedure. The tendon pulley system is essential for the proper flexion of the fingers, consisting of a series of annular and cruciate pulleys that facilitate the movement of tendons. Each finger has five annular pulleys and four cruciate pulleys, while the thumb is supported by two annular pulleys and one oblique pulley. Among these, the second annular (A2) and fourth annular (A4) pulleys in the fingers are particularly crucial for maintaining finger function, while the oblique pulley plays a vital role in thumb movement. When a critical pulley sustains an injury, it can severely compromise the ability to flex the finger unless surgical intervention is performed to reconstruct the pulley. This reconstruction can be achieved using local tissues, such as the flexor digitorum superficialis (FDS), which is harvested or rearranged to repair the damaged pulley. The procedure involves exposing the injured pulley, excising any damaged tissue, and securing the harvested tissue to the remnant of the pulley. The reconstruction may involve passing the tissue through drill holes in the bone or wrapping it around the phalanx to restore the pulley’s function. After the reconstruction, the range of motion is assessed, and the tension is adjusted to ensure optimal snugness. This code is applicable for each tendon requiring the reconstruction of one or more pulleys, emphasizing the importance of precise surgical technique and careful postoperative management to ensure successful outcomes.
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The reconstruction of tendon pulleys using CPT® Code 26500 is indicated for specific conditions that compromise the integrity and function of the pulley system in the fingers and thumb. These indications include:
The procedure for reconstructing tendon pulleys as described by CPT® Code 26500 involves several critical steps:
Post-procedure care following the reconstruction of tendon pulleys is essential for optimal recovery. Patients are typically advised to keep the hand elevated to reduce swelling and to follow specific instructions regarding the care of the surgical site. The bulky dressing and splint are usually maintained for a specified period to immobilize the finger and allow for proper healing. Follow-up appointments are necessary to monitor the healing process, assess the range of motion, and make any adjustments to the rehabilitation plan. Physical therapy may be recommended to restore strength and flexibility to the finger after the initial healing period, ensuring that the patient can regain full function.
| Short Descr | HAND TENDON RECONSTRUCTION | Medium Descr | RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX | Long Descr | Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure) | 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 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.) | 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.) | 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 | 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 | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| Pre-1990 | Added | Code added. |
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