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The CPT® Code 26676 refers to the procedure known as percutaneous skeletal fixation of carpometacarpal dislocation, specifically for dislocations other than the thumb, and includes manipulation for each joint involved. This procedure is performed to address dislocations of the carpometacarpal joints, which are the joints located between the carpal bones of the wrist and the metacarpal bones of the hand. The term 'percutaneous' indicates that the procedure is performed through a small incision in the skin, minimizing tissue damage and promoting quicker recovery. During the procedure, a small drill is utilized to create a corticotomy, which is an incision into the cortex of the bone, allowing access to the dislocated carpometacarpal bones. The surgeon then carefully reduces the dislocated bones, restoring them to their normal anatomical position. To secure the bones in place, one or more pre-bent Kirschner wires are inserted into the metacarpal medullary canal, traversing the carpometacarpal joint and anchoring into the carpal bone. This fixation method is crucial for maintaining the alignment of the bones during the healing process. Following the procedure, the anatomical reduction of the dislocation is confirmed through radiographic imaging, ensuring that the bones are properly aligned before concluding the intervention. It is important to report code 26676 for each carpometacarpal joint dislocation that is treated using this percutaneous fixation technique.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 26676 is indicated for the treatment of carpometacarpal dislocations, specifically those that do not involve the thumb. These dislocations may occur due to trauma, such as falls or direct impacts to the hand, leading to misalignment of the carpometacarpal joints. Symptoms that may prompt this procedure include significant pain, swelling, and loss of function in the affected hand, as well as visible deformity at the site of the dislocation. The goal of the procedure is to restore normal anatomy and function to the hand, alleviating pain and preventing long-term complications associated with untreated dislocations.
The procedure begins with the surgeon making a small skin incision over the metacarpal bone, which allows for direct access to the underlying structures. Following the incision, a small drill is utilized to create a corticotomy, an essential step that involves making an incision into the outer layer of the bone. This corticotomy facilitates access to the dislocated carpometacarpal bones. Once access is achieved, the surgeon carefully manipulates the dislocated bones back into their proper anatomical alignment, a process known as reduction. This step is critical to ensure that the bones are positioned correctly to promote healing and restore function. After the reduction is completed, the surgeon advances one or more pre-bent Kirschner wires into the metacarpal medullary canal. These wires are strategically placed to cross the carpometacarpal joint and anchor into the carpal bone, providing stability to the reduced joint. The final step of the procedure involves verifying the anatomical reduction radiographically, using imaging techniques to confirm that the bones are properly aligned before concluding the intervention. This thorough approach ensures that the dislocation is effectively treated and that the integrity of the carpometacarpal joint is maintained.
After the completion of the percutaneous skeletal fixation procedure, the patient will typically be monitored for any immediate complications. Post-procedure care may include immobilization of the hand to ensure that the carpometacarpal joint remains stable during the initial healing phase. Patients are often advised to follow up with their healthcare provider for further evaluation and to assess the healing process. Pain management strategies may be implemented to address any discomfort following the procedure. Additionally, rehabilitation exercises may be recommended to restore range of motion and strength in the hand once the initial healing has occurred. It is essential for patients to adhere to their post-procedure instructions to optimize recovery and prevent any potential complications.
| Short Descr | PIN HAND DISLOCATION | Medium Descr | PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT | Long Descr | Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint | 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 | 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). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | E2 | Lower left, eyelid | 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 | 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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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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