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The procedure described by CPT® Code 26034 involves an incision into the bone cortex of the hand or finger, specifically targeting conditions such as osteomyelitis or a bone abscess. Osteomyelitis refers to an infection of the bone, while a bone abscess is a localized collection of pus within the bone. The bones involved in this procedure include the metacarpals of the hand and the proximal, middle, and distal phalanges of the fingers. During the procedure, an incision is made through the skin and soft tissue to access the infected area of the bone. The periosteum, which is the dense layer of vascular connective tissue enveloping the bones, is elevated to expose the underlying bone cortex. A small section, or button, of the cortical bone is then removed to access the bone marrow, which is crucial for alleviating pressure caused by inflammation and preventing further restriction of blood flow to the infected area. If pus is present, the initial incision may be enlarged using specialized instruments such as a chisel or gouge, allowing for effective drainage of the abscess. In cases where the epiphysis, the end part of a long bone, is affected, a portion of the epiphyseal cortex may also be excised to ensure complete drainage and treatment of the infection.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 26034 is indicated for specific conditions affecting the bone cortex of the hand or fingers. These include:
The procedure involves several critical steps to effectively treat the infected bone. The first step is to make an incision in the skin over the affected area, which allows access to the underlying soft tissue. This incision is carefully extended through the soft tissue to reach the periosteum, the protective layer surrounding the bone. Once the periosteum is exposed, it is elevated to provide a clear view of the bone cortex beneath. The next step involves the removal of a small button of cortical bone, which is essential for accessing the bone marrow. This access is crucial as it relieves pressure caused by inflammation within the bone marrow, thereby restoring blood flow to the infected area. If the procedure reveals the presence of frank pus, the surgeon may need to enlarge the initial incision. This is done using a chisel or gouge to extend the opening along the bone for a distance of one to two inches, facilitating thorough drainage of the abscess. In cases where the epiphysis is involved, a section of the epiphyseal cortex may also be excised to ensure complete removal of infected tissue and effective drainage of the abscess.
After the procedure, appropriate post-operative care is essential for recovery. The surgical site will require monitoring for signs of infection and proper healing. Patients may be advised to keep the area clean and dry, and follow-up appointments will be necessary to assess the healing process. Pain management may be provided as needed, and physical therapy could be recommended to restore function and mobility in the hand or finger. It is important to follow the surgeon's instructions regarding activity restrictions and care of the incision site to ensure optimal recovery and prevent complications.
| Short Descr | TREAT HAND BONE LESION | Medium Descr | INCISION BONE CORTEX HAND/FINGER | Long Descr | Incision, bone cortex, hand or finger (eg, osteomyelitis or bone abscess) | 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) | 1 - Statutory 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 | 2 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
| 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). | 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. | 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. | 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) | SG | Ambulatory surgical center (asc) facility service | TA | Left foot, great toe | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 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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