Summary & Overview
CPT 26011: Incision and Drainage of Finger Abscess (Felon)
CPT code 26011 represents incision and drainage of a finger abscess (eg, felon), a common minor surgical procedure to evacuate purulent material and relieve fingertip pulp infections. This code matters nationally because fingertip infections are frequent presentations across ambulatory, urgent care, and emergency settings; appropriate coding ensures accurate capture of surgical services, influences reimbursement, and supports antimicrobial stewardship and follow-up care metrics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 26011, typical sites of service, and the service type. The publication summarizes payer coverage considerations and commonly used procedural modifiers (listed separately), and highlights benchmarking and policy-relevant points to inform billing accuracy and audit readiness.
This piece provides clinicians, billers, and policy analysts with practical information on where this procedure is typically performed, why correct coding is important for quality measurement and payment, and what to expect in payer interactions and documentation review. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 26011 describes the surgical drainage of a finger abscess, commonly performed for conditions such as a felon, an infection of the pulp of the fingertip. The procedure involves incision and drainage of an infected digital pulp to evacuate purulent material and relieve pressure.
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Service type: Minor surgical procedure (incision and drainage)
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Typical site of service: Ambulatory surgical center or outpatient clinic procedure room, and emergency department when performed for acute infections
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual presenting to an urgent care clinic, emergency department, or outpatient hand clinic with a painful, swollen fingertip localized to the distal pulp suggestive of a felon or other paronychial abscess. The patient commonly reports a recent puncture wound, splinter, or paronychia with progressive throbbing pain, erythema, fluctuance, and decreased range of motion of the distal interphalangeal joint. Vital signs may be normal or show low-grade fever. The clinical workflow includes focused history and physical exam, assessment of neurovascular status of the digit, consideration of plain radiographs if suspected foreign body or osteomyelitis, consent discussion for incision and drainage, application of local anesthesia (digital block), preparation and sterile draping of the finger, performance of an incision and drainage of the abscess with exploration of the pus cavity, copious irrigation, possible placement of a small wick or packing if indicated, tetanus status review, wound care instructions, and prescription of oral antibiotics if indicated. The typical site of service is outpatient clinic, urgent care, or emergency department. The service type is minor surgical procedure (incision and drainage) on a single finger pulp. Follow-up usually occurs within 48–72 hours to reassess infection and wound healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time is substantially greater than typical for the procedure (document specific reasons). |