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The procedure described by CPT® Code 26502 involves the reconstruction of a tendon pulley, specifically utilizing a tendon or fascial graft. This procedure is categorized as a separate procedure, which means it is performed independently and is not part of a more comprehensive surgical intervention. 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. In the fingers, the second annular (A2) and fourth annular (A4) pulleys are particularly crucial, while the thumb relies on the oblique pulley for its flexion capabilities. When a critical pulley sustains an injury, the ability to flex the finger is significantly impaired unless surgical reconstruction is performed. The reconstruction process may involve the use of local tissue, such as the flexor digitorum superficialis (FDS), or a graft harvested from another site, typically the forearm or leg. The procedure entails exposing the damaged pulley, excising any compromised tissue, and securing the graft to reconstruct the pulley structure. This meticulous approach ensures that the pulley is restored to its functional state, allowing for improved range of motion and finger dexterity post-surgery.
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The reconstruction of tendon pulleys using CPT® Code 26502 is indicated for patients who have sustained injuries to critical pulleys that compromise finger flexion. The specific indications for this procedure include:
The procedure for reconstructing a tendon pulley as described by CPT® Code 26502 involves several critical steps:
Post-procedure care following the reconstruction of tendon pulleys involves monitoring the surgical site for signs of infection and ensuring proper healing. Patients are typically advised to keep the hand elevated and immobilized in a splint to minimize swelling and promote recovery. Physical therapy may be recommended to restore range of motion and strength in the affected finger or thumb as healing progresses. Follow-up appointments are essential to assess the success of the reconstruction and make any necessary adjustments to the rehabilitation plan.
| Short Descr | HAND TENDON RECONSTRUCTION | Medium Descr | RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX | Long Descr | Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (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) | 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 |
| 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. | 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 | 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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