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The procedure described by CPT® Code 26546 pertains to the surgical repair of a non-union in the metacarpal or phalanx bones. A non-union occurs when the fracture fragments fail to heal together after an adequate period, resulting in a persistent gap at the fracture site. This condition necessitates surgical intervention to promote healing and restore function. During the procedure, the surgeon exposes the original fracture site to assess the non-union and determine the appropriate method of repair. This may involve the use of internal fixation devices, such as pins or wires, and/or external fixation methods to stabilize the bone fragments. Additionally, a bone graft may be utilized to fill any defects and facilitate the healing process. The graft can be harvested from the patient's own body, typically from the iliac crest, where a skin incision is made, and the underlying muscle is carefully stripped to access the bone. The harvested bone is then shaped to fit the defect or morcellized and packed into the area to encourage union. The combination of these techniques aims to achieve successful healing of the non-union and restore the structural integrity of the metacarpal or phalanx.
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The procedure is indicated for patients who present with a non-union of the metacarpal or phalanx bones. This condition may arise due to various factors, including inadequate initial treatment of a fracture, insufficient blood supply to the fracture site, or excessive movement at the fracture location. The following specific indications warrant the surgical intervention described by CPT® Code 26546:
The surgical procedure for repairing a non-union of the metacarpal or phalanx involves several key steps, each crucial for ensuring successful healing and restoration of function. The following procedural steps are outlined:
After the surgical repair of the non-union, post-procedure care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or graft failure. Pain management strategies are implemented to ensure patient comfort during the recovery phase. Rehabilitation may be initiated to restore mobility and strength in the affected hand or finger, with physical therapy often recommended to facilitate healing and improve function. Follow-up appointments are scheduled to assess the healing progress and determine if any further interventions are necessary. The overall goal of post-procedure care is to ensure successful union of the bone and return the patient to their normal activities as soon as possible.
| Short Descr | REPAIR NONUNION HAND | Medium Descr | RPR NON-UNION MTCRPL/PHALANX | Long Descr | Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation) | 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) | 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) | P3D - Major procedure, orthopedic - other | 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). | 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). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 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 | T5 | Right foot, great toe | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2008-01-01 | Changed | Code description changed. |
| 1997-01-01 | Added | First appearance in code book in 1997. |