Summary & Overview
CPT 26140: Synovectomy and Extensor Tendon Reconstruction, PIP Joint
CPT code 26140 identifies a surgical synovectomy of a single proximal interphalangeal (PIP/IP) joint with concurrent extensor tendon reconstruction, commonly performed for patients with rheumatoid arthritis. This procedure addresses painful, inflamed synovium and tendon dysfunction to improve joint function and reduce progressive damage. Nationally, 26140 is relevant to orthopedic hand surgeons, rheumatologists coordinating care, surgical facilities, and payers managing coverage for hand reconstructive procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview of the procedure, guidance on typical settings where the service is provided (operating room or ambulatory surgical center), and the common clinical context for use. The publication highlights the service line classification (surgical hand/finger reconstruction) and outlines areas where policy updates or payer-specific coverage nuances commonly apply.
This summary prepares readers to interpret benchmarks, billing practices, and coding considerations related to 26140, and to locate deeper resources on billing modifiers, diagnosis coding, and payer policies. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes is noted for readers seeking supplementary references.
Billing Code Overview
CPT code 26140 describes a surgical procedure that removes the synovial membrane over a single proximal interphalangeal (PIP/IP) joint and includes reconstruction of the extensor tendons. The procedure is commonly performed to treat rheumatoid arthritis and other inflammatory or degenerative conditions affecting the IP joint.
Service type: Surgical — hand/finger reconstructive surgery
Typical site of service: Operating room or ambulatory surgical center, with perioperative care provided in a hospital or outpatient surgical setting depending on patient condition and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 62-year-old right-hand-dominant female with long-standing seropositive rheumatoid arthritis presents with persistent pain, swelling, and progressive extensor tendon dysfunction of the left index finger proximal interphalangeal (PIP) joint despite optimized medical therapy. Physical exam shows synovial swelling, limited PIP extension with active extensor lag, and crepitus. Imaging demonstrates synovial proliferation and erosive changes localized to a single PIP joint without fracture. The surgeon schedules a procedure for synovectomy of the affected proximal interphalangeal joint and extensor tendon reconstruction under regional block with monitored anesthesia care. Intraoperative steps include exposure of the PIP joint, resection of inflamed synovium, assessment and repair or reconstruction of the extensor tendon mechanism (tenorrhaphy, tendon graft, or advancement as indicated), hemostasis, and layered closure. Postoperative care includes immobilization in a splint, pain control, wound checks, and hand therapy for range-of-motion and strengthening. Documentation includes the specific joint treated (e.g., left index PIP), operative findings, the reconstructive technique performed on the extensor tendon, anesthesia type, estimated blood loss, and return-to-function expectations for the payer and coding review.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Use when this synovectomy and extensor tendon reconstruction is distinct from other procedures performed on the same digit or hand during the same operative session. |