Summary & Overview
CPT 26110: Interphalangeal Joint Soft-Tissue Biopsy, Finger
CPT code 26110 denotes a surgical biopsy procedure of the soft tissues within a finger interphalangeal joint. The code captures an incision and direct sampling of intra-articular or periarticular soft tissue for diagnostic pathology. As a targeted minor surgical procedure on a digit, it is relevant across hand surgery, orthopedics, plastic surgery, and outpatient surgical practices.
Key national payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage and coding implications that affect facility and professional billing, common modifier use, and appropriate site-of-service considerations.
Readers will find a concise clinical context for when CPT code 26110 applies, typical service settings where the procedure is performed, and what to expect in payer review and claim adjudication. The publication outlines benchmarks and common billing themes, highlights policy and documentation points that commonly influence coverage decisions, and provides a practical summary for revenue cycle, coding, and clinical teams seeking clarity on use of the code. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 26110 describes a surgical procedure in which a provider makes an incision to open an interphalangeal joint of a finger and obtains a biopsy of the soft tissue. This is a minor surgical biopsy of a finger joint involving direct access to the interphalangeal joint space.
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Service type: Surgical soft-tissue biopsy
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an office procedure setting depending on clinical circumstances and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient orthopedic or hand surgery clinic with a painful, swollen distal interphalangeal or proximal interphalangeal joint of a finger. Conservative measures (splinting, NSAIDs, antibiotics if infectious concern) have not resolved symptoms or imaging suggests an intra-articular mass or synovial abnormality. The provider schedules a minor procedure in an ambulatory surgical center or office-based procedure room under local anesthesia with or without monitored anesthesia care. The procedure involves a small incision over the affected interphalangeal joint, joint exposure or arthrotomy, and collection of soft tissue for pathological examination (biopsy) to evaluate for infection, inflammatory arthropathy, synovial tumor, or neoplasm. Post-procedure the specimen is submitted to pathology, the incision is irrigated and closed, and the patient is given wound care instructions and short-term analgesia. Follow-up is arranged for pathology results and definitive management based on findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the biopsy required substantially greater effort, extended operating time, or more extensive dissection than typical for 26110. |