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The CPT® Code 26706 refers to the procedure known as percutaneous skeletal fixation of a metacarpophalangeal dislocation, specifically for a single joint, accompanied by manipulation. This procedure is performed to address dislocations of the metacarpophalangeal joint, which is the joint located between the metacarpal bones of the hand and the proximal phalanges of the fingers. In this minimally invasive technique, a small incision is made over the proximal phalanx, allowing access to the joint without the need for extensive surgical exposure. A specialized drill is utilized to create a corticotomy, which is a surgical procedure that involves cutting through the cortex of the bone to facilitate access to the underlying structures. Once the dislocated bones are properly aligned, they are reduced back to their anatomical position. To secure the joint in place, one or more pre-bent Kirschner wires are inserted into the phalangeal medullary canal, traversing the metacarpophalangeal joint and anchoring into the metacarpal bone. This fixation method helps maintain the alignment of the joint during the healing process. The success of the procedure is confirmed through radiographic imaging, ensuring that the dislocation has been adequately addressed. The code 26706 should be reported for each metacarpophalangeal joint dislocation that is treated using this percutaneous fixation technique.
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The procedure described by CPT® Code 26706 is indicated for the treatment of metacarpophalangeal joint dislocations. These dislocations may occur due to trauma, such as sports injuries, falls, or accidents, leading to pain, swelling, and loss of function in the affected finger. The primary goal of this procedure is to restore the normal anatomical alignment of the dislocated joint, thereby alleviating symptoms and preventing long-term complications such as joint stiffness or arthritis.
The procedure begins with the patient positioned appropriately to allow access to the affected hand. A small skin incision is made over the proximal phalanx, which is the bone in the finger closest to the hand. This incision is minimal, aimed at reducing tissue damage and promoting quicker recovery. Following the incision, a small drill is utilized to create a corticotomy, which involves carefully cutting through the outer layer of the bone to gain access to the joint space. Once the corticotomy is performed, the dislocated metacarpophalangeal bones are manipulated back into their correct anatomical alignment. This reduction process is critical, as it restores the normal function of the joint. After achieving proper alignment, one or more pre-bent Kirschner wires are advanced by hand into the phalangeal medullary canal. These wires are inserted across the metacarpophalangeal joint and into the metacarpal bone, providing stability and fixation to the joint. The final step involves verifying the anatomical reduction of the dislocation through radiographic imaging, ensuring that the bones are correctly positioned before concluding the procedure. It is important to report CPT® Code 26706 for each metacarpophalangeal joint dislocation treated by this percutaneous fixation method.
After the completion of the procedure, the patient will typically be monitored for any immediate complications. Post-procedure care may include immobilization of the affected finger to ensure proper healing and stability of the joint. Patients are often advised on pain management strategies and may be prescribed analgesics to alleviate discomfort. Follow-up appointments are essential to assess the healing process and to remove any fixation devices, such as the Kirschner wires, once adequate healing has occurred. Rehabilitation exercises may also be recommended to restore range of motion and strength in the finger as part of the recovery process. It is crucial for patients to adhere to the post-procedure instructions provided by their healthcare provider to ensure optimal recovery and function of the hand.
| Short Descr | PIN KNUCKLE DISLOCATION | Medium Descr | PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ | Long Descr | Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, 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) | 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.) | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | 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 | 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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