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Official Description

Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Reconstruction of the collateral ligament of the metacarpophalangeal (MCP) joint is a surgical procedure aimed at addressing injuries to the ligament that may occur due to trauma, such as lacerations or ruptures. The collateral ligaments are critical for the stability of the MCP joint, which is located at the base of the fingers. When these ligaments are compromised, it can lead to instability and impaired function of the hand. The procedure involves either the use of local tissue, such as in the case of adductor advancement, or the application of a graft from another tendon or fascia. The choice of technique depends on the nature and extent of the injury. In cases where an open wound is present, the surgical approach includes exploration of the wound, debridement of any devitalized tissue, and removal of foreign materials. For closed injuries, a volar incision is made to access the MCP joint, allowing for careful dissection to protect neurovascular structures while evaluating the extent of the ligament injury. The reconstruction aims to restore the integrity and function of the MCP joint, facilitating a return to normal hand activities.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Reconstruction of the collateral ligament of the metacarpophalangeal (MCP) joint is indicated for the following conditions:

  • Traumatic Injury The procedure is performed to address injuries such as lacerations or ruptures of the collateral ligament, which can result from accidents or sports-related incidents.
  • Joint Instability Patients exhibiting instability of the MCP joint due to ligament damage may require reconstruction to restore proper function and stability.
  • Chronic Pain or Dysfunction Individuals experiencing chronic pain or dysfunction in the MCP joint related to ligament injuries may benefit from this surgical intervention.

2. Procedure

The procedure for reconstructing the collateral ligament of the MCP joint involves several key steps:

  • Step 1: Wound Exploration In cases of open injury, the surgical team begins by exploring the wound to assess the extent of the damage. This includes debriding any devitalized tissue and removing foreign materials to prepare the site for reconstruction.
  • Step 2: Incision for Closed Injury For closed injuries, a volar incision is made over the affected MCP joint. This incision allows access to the underlying structures while minimizing damage to surrounding tissues.
  • Step 3: Dissection and Identification The subcutaneous tissue and fascia are carefully dissected to expose the neurovascular bundles, which are identified and protected throughout the procedure to prevent injury.
  • Step 4: Exposure of the Collateral Ligament The injured collateral ligament is then exposed, and the extent of the injury is evaluated to determine the appropriate reconstruction technique.
  • Step 5: Graft Harvesting (if applicable) If a tendon or fascial graft is required, an incision is made over the harvest site, and the necessary length of tendon or fascia is excised. Common graft sources include the palmaris longus tendon or other suitable tendons.
  • Step 6: Graft Attachment The harvested graft is attached to the remnants of the ligament or bony structures using sutures or bone anchors, ensuring proper tension and alignment.
  • Step 7: Local Tissue Repair (for CPT® Code 26542) In cases where local tissue is used, such as adductor advancement, the adductor tendon is exposed, detached from its insertion site, and relocated distally to enhance the stability of the MCP joint.
  • Step 8: Closure After the reconstruction is complete, the wound is closed in layers to promote healing and minimize complications.
  • Step 9: Range of Motion Evaluation Finally, the range of motion of the MCP joint is evaluated, and the tension of the graft is adjusted as necessary to ensure optimal function.

3. Post-Procedure

Post-procedure care following the reconstruction of the collateral ligament of the MCP joint typically includes monitoring for signs of infection, managing pain, and ensuring proper wound healing. Patients may be advised to limit movement of the affected joint initially to allow for healing. Rehabilitation exercises may be introduced gradually to restore range of motion and strength. Follow-up appointments are essential to assess the recovery process and make any necessary adjustments to the rehabilitation plan. The expected recovery time can vary based on the extent of the injury and the specific surgical technique employed.

Short Descr REPAIR HAND JOINT WITH GRAFT
Medium Descr RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
Long Descr Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)
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 Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5B - Ambulatory procedures - musculoskeletal
MUE 4
CCS Clinical Classification 162 - Other OR therapeutic procedures on joints
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.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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)
SG Ambulatory surgical center (asc) facility service
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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