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The CPT® Code 26100 refers to an arthrotomy with biopsy specifically performed on the carpometacarpal (CMC) joint, which is one of the five joints located in each hand. The CMC joints are critical articulations that connect the distal row of carpal bones in the wrist to the proximal ends of the metacarpal bones that form the palm. This procedure involves making an incision over the affected CMC joint, allowing for access to the joint capsule. During the arthrotomy, the surgeon carefully dissects the surrounding soft tissues while protecting nearby nerves and blood vessels. Once the joint capsule is exposed, it is incised to allow for visual inspection of the joint interior. Tissue samples are then collected from the joint capsule and/or the synovial membrane for laboratory evaluation, which is essential for diagnosing various conditions affecting the joint. It is important to note that if the procedure is performed on the metacarpophalangeal (MCP) joint, CPT® Code 26105 should be used, and for the interphalangeal (IP) joint, CPT® Code 26110 is applicable. Each of these procedures is reported separately for each joint treated, ensuring accurate coding and billing for the services rendered.
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The procedure described by CPT® Code 26100 is indicated for various conditions affecting the carpometacarpal (CMC) joint. These may include:
The procedure for CPT® Code 26100 involves several critical steps to ensure proper access and evaluation of the carpometacarpal joint. The first step is to make an incision in the skin directly over the affected CMC joint. This incision allows the surgeon to access the underlying structures. Following the incision, the surgeon carefully dissects the soft tissues surrounding the joint, taking special care to protect the nearby nerves and blood vessels to prevent any potential damage. Once the soft tissues are adequately dissected, the joint capsule is exposed. The next step involves incising the joint capsule, which provides direct access to the interior of the joint. At this point, the surgeon visually inspects the joint to assess its condition. After the inspection, tissue samples are obtained from either the joint capsule or the synovial membrane. These samples are crucial for further laboratory evaluation, which can help in diagnosing various joint conditions. It is important to note that this procedure is reported for each separate joint treated, ensuring accurate coding for the services provided.
After the arthrotomy with biopsy of the carpometacarpal joint, appropriate post-procedure care is essential for optimal recovery. Patients may experience some pain and swelling in the area, which can be managed with prescribed pain relief medications. It is important for patients to follow the surgeon's instructions regarding activity restrictions to avoid stressing the joint during the healing process. Additionally, the surgical site should be monitored for any signs of infection, such as increased redness, warmth, or discharge. Follow-up appointments may be scheduled to assess healing and discuss the results of the laboratory evaluations performed on the obtained tissue samples. Rehabilitation exercises may also be recommended to restore range of motion and strength in the joint as healing progresses.
| Short Descr | BIOPSY HAND JOINT LINING | Medium Descr | ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH | Long Descr | Arthrotomy with biopsy; carpometacarpal joint, each | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 | 1 | CCS Clinical Classification | 159 - Other diagnostic procedures on musculoskeletal system |
| 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. | 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.) | 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 | F5 | Right hand, thumb | 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) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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