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The procedure described by CPT® Code 26785 pertains to the open treatment of dislocations occurring in the interphalangeal joints, which are the joints located between the phalanges (bones) of the fingers and toes. This procedure involves a surgical approach to reduce the dislocation, which means to restore the joint to its normal anatomical position. The term 'open treatment' indicates that the procedure is performed through an incision, allowing direct access to the joint. In cases where internal fixation is necessary, this procedure includes the application of devices such as K wires to stabilize the joint after reduction. The surgical approach typically involves making a curvilinear incision on the dorsal side of the hand, which is the back side, and carefully dissecting through the surrounding tissues to reach the extensor mechanism, which is crucial for finger movement. The procedure also includes repairing the central slip, a part of the extensor tendon that is essential for proper finger function. It is important to note that if multiple interphalangeal joints require treatment, each joint treated should be reported using the same CPT® code, 26785, ensuring accurate documentation and billing for the services rendered.
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The open treatment of interphalangeal joint dislocation, as described by CPT® Code 26785, is indicated for patients presenting with dislocated interphalangeal joints. This condition may arise due to trauma, such as falls or sports injuries, leading to the misalignment of the joint. Symptoms that may prompt this procedure include significant pain, swelling, and an inability to move the affected finger or toe, which can severely impact hand or foot function. The procedure is typically considered when conservative treatment methods, such as closed reduction, are insufficient to restore joint alignment or when there is associated damage to the surrounding structures that necessitates surgical intervention.
The procedure for the open treatment of interphalangeal joint dislocation involves several critical steps to ensure proper alignment and stabilization of the joint. Initially, a curvilinear incision is made on the dorsal aspect of the hand, directly over the dislocated interphalangeal joint. This incision allows the surgeon to access the joint while minimizing damage to surrounding tissues. Following the incision, the tissue is carefully dissected down to the extensor mechanism, which is essential for finger movement. The surgeon then makes an incision between the lateral bands and the central slip of the extensor tendon. This step is crucial as it allows for the retraction of the lateral bands, providing a clear view of the joint for reduction. Once the joint is exposed, the dislocated joint is reduced, meaning it is maneuvered back into its proper anatomical position. After achieving reduction, the central slip, which may have been damaged during the dislocation, is repaired to restore the integrity of the extensor mechanism. If necessary, internal fixation is applied to stabilize the joint, with a K wire commonly used for this purpose. Finally, the extensor mechanism is repaired, and the skin is closed to complete the procedure, ensuring that the joint is properly aligned and stabilized for optimal recovery.
After the open treatment of an interphalangeal joint dislocation, patients can expect a recovery period that may involve immobilization of the affected digit to promote healing. The use of a splint or cast may be necessary to maintain joint stability during the initial healing phase. Pain management is typically addressed with prescribed medications, and patients are advised to follow up with their healthcare provider to monitor the healing process. Rehabilitation exercises may be introduced gradually to restore range of motion and strength once the initial healing has occurred. It is essential for patients to adhere to post-operative care instructions to ensure optimal recovery and prevent complications such as stiffness or re-dislocation of the joint.
| Short Descr | TREAT FINGER DISLOCATION | Medium Descr | OPEN TX INTERPHALANGEAL JOINT DISLOCATION | Long Descr | Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, single | 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 | 3 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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). | 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.) | 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 | CR | Catastrophe/disaster related | 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 | GW | Service not related to the hospice patient's terminal condition | 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 | T2 | Left foot, third digit | T5 | Right foot, great toe | T9 | Right foot, fifth digit | 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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| 2008-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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