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A carpometacarpal fracture dislocation of the thumb, commonly referred to as a Bennett fracture, involves a fracture at the base of the thumb that affects the carpometacarpal joint. This type of injury is characterized by the dislocation of the thumb metacarpal bone, which is the bone that connects the thumb to the wrist, and it often includes significant displacement of the fracture fragments. The procedure described by CPT® Code 26650 involves the use of manipulation and percutaneous skeletal fixation to correct this injury. During the procedure, the surgeon applies traction to the thumb while simultaneously extending, pronating, and abducting the metacarpal to properly align the fractured bone fragments. Following the reduction of the fracture dislocation, the surgeon employs K wires, which are thin metal pins, to stabilize the fracture. These K wires are inserted through the dorsal radial aspect of the thumb metacarpal base and into the reduced volar ulnar fragment. In cases where the fracture involves a very small fragment, the K wire may be directed from the thumb metacarpal into the trapezium bone or the index metacarpal to ensure adequate fixation and promote healing.
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The procedure described by CPT® Code 26650 is indicated for the treatment of specific conditions related to the thumb, particularly:
The procedure for percutaneous skeletal fixation of a carpometacarpal fracture dislocation of the thumb involves several critical steps to ensure proper alignment and stabilization of the fracture:
Following the procedure, the patient is typically monitored for any immediate complications. Post-procedure care may include immobilization of the thumb and hand to promote healing and prevent movement that could disrupt the fixation. The patient may be advised on pain management strategies and instructed on how to care for the surgical site. Follow-up appointments are essential to assess the healing process and to determine when it is safe to begin rehabilitation exercises to restore function and strength to the thumb.
| Short Descr | TREAT THUMB FRACTURE | Medium Descr | PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB | Long Descr | Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation | 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) | 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 | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F4 | Left hand, fifth digit | 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) | SG | Ambulatory surgical center (asc) facility service |
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| 2008-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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