Orthopedic Coding Alert

Question: Which code should I use for reconstruction of the A1 and A2 pulleys of the right hand?

Tennessee Subscriber  
Answer: Tendon pulleys are the thickened areas of the tendon sheath that keep the flexor tendons in place. Each flexor tendon has multiple tendon pulleys, and these are labeled according to type.
 
Type A represents annular, and C represents cruciate, and they are numbered according to their position on the tendon, with the A1 pulley positioned closest to the hand, and the A4 pulley positioned near the fingertip. The appropriate code choice depends on the technique that your surgeon used when he reconstructed the pulleys.
 
If he used local tissues, you should report 26500 (Reconstruction of tendon pulley, each tendon; with local tissues [separate procedure]). If the surgeon used a tendon or fascial graft for reconstruction, you should instead report 26502 (Reconstruction of tendon pulley, each tendon; with tendon or fascial graft [includes obtaining graft] [separate procedure]). 
 
In some cases, a surgeon will use an artificial tendon prosthesis to reconstruct a patients tendon pulley. In this case, you should report 26504 (Reconstruction of tendon pulley, each tendon; with tendon prosthesis [separate procedure]). The code descriptions specify each tendon, not each pulley, so you should report the code only once for each tendon involved.