CPT® Code 26500

The procedure described by CPT® Code 26500 involves the reconstruction of a tendon pulley using local tissues, classified as a separate procedure. The tendon pulley system is essential for the proper flexion of the fingers, consisting of a series of annular and cruciate pulleys that facilitate the movement of tendons. Each finger has five annular pulleys and four cruciate pulleys, while the thumb is supported by two annular pulleys and one oblique pulley. Among these, the second annular (A2) and fourth annular (A4) pulleys in the fingers are particularly crucial for maintaining finger function, while the oblique pulley plays a vital role in thumb movement. When a critical pulley sustains an injury, it can severely compromise the ability to flex the finger unless surgical intervention is performed to reconstruct the pulley. This reconstruction can be achieved using local tissues, such as the flexor digitorum superficialis (FDS), which is harvested or rearranged to repair the damaged pulley. The procedure involves exposing the injured pulley, excising any damaged tissue, and securing the harvested tissue to the remnant of the pulley. The reconstruction may involve passing the tissue through drill holes in the bone or wrapping it around the phalanx to restore the pulley’s function. After the reconstruction, the range of motion is assessed, and the tension is adjusted to ensure optimal snugness. This code is applicable for each tendon requiring the reconstruction of one or more pulleys, emphasizing the importance of precise surgical technique and careful postoperative management to ensure successful outcomes.