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William Ivan Posted Wed 09th of January, 2019 13:14:16 PM
UHC is bundling cpt 26442 into cpt 26356. We sent in op report showing that both services were performed and the billing of a '59' on 26442 is valid. After review of records UHC states our records do not support the procedure was distinct or independent from other services performed, therefore the use of 59 modifier is not supported. Do we need to update the modifier used on 26442 or should we move forward with an appeal?
SuperCoder Answered Thu 10th of January, 2019 03:24:51 AM

Hi,

CPT 26356 (Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); primary, without free graft, each tendon) is used when surgeon repairs or advances a single flexor tendon located in "no man's land. The physician makes volar digital incision over the skin of the palm and finger to access the tendons. He takes care to prevent damage to the pulleys. He repairs a laceration of the superficial flexor tendon with horizontal mattress sutures. If the deep flexor tendon is also lacerated, he uses simple running stitches to repair it.

On the other hand, CPT 26442 (Tenolysis, flexor tendon; palm AND finger, each tendon) is used for when surgeon performs tenolysis, which releases the flexor tendon of the palm and finger from adhesions. If CPT codes 26356 and 26442 has performed on same anatomical location or area, then 26442 will be consider inclusive in 26536. If CPT codes 26356 and 26442 are performing on two different area or different anatomical site, then CPT 26536 and 26442 can be billed together with 59 modifier on 26442.

Thanks

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