Summary & Overview
CPT 26185: Excision of Sesamoid Bone of Thumb or Finger
CPT code 26185 represents the surgical excision of a sesamoid bone in the thumb or finger, a targeted hand procedure commonly used to address sesamoid fractures or persistent pain related to sesamoid pathology. Nationally, this code matters because it captures a discrete, procedure-driven intervention in hand surgery that affects facility and professional billing, utilization monitoring, and clinical coding accuracy. Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and coding overview of the procedure, understand typical sites of service and service type, and find context for how the code is applied in surgical hand care. The publication outlines expected documentation themes, common modifiers used with this code (input provided), and guidance on areas where coding clarity affects claims processing. It also highlights the clinical intent of the procedure—removal of a symptomatic or fractured sesamoid—to help align coding with operative reports and diagnosis documentation. Data not available in the input include specific ICD-10 diagnosis mappings, payer-specific reimbursement benchmarks, and associated taxonomies.
Billing Code Overview
CPT code 26185 describes the excision (removal) of a sesamoid bone of the thumb or finger, commonly performed to correct a sesamoid bone fracture. The procedure involves surgical removal of the small accessory bone located within the tendon of the affected digit to relieve pain, restore function, or treat nonunion following fracture.
Service type: Surgical procedure — hand/finger surgery
Typical site of service: Outpatient surgical suite or ambulatory surgery center; may also be performed in an inpatient operating room depending on clinical circumstances
Clinical & Coding Specifications
Clinical Context
A 34-year-old right-hand–dominant woman presents with persistent radial-sided thumb pain after a direct blow to the thumb three weeks earlier while playing soccer. Conservative care including splinting, NSAIDs, and activity modification failed to relieve pain. Imaging (plain radiographs and CT) demonstrates a displaced fracture of the sesamoid of the thumb with ongoing pain and mechanical symptoms. The hand surgeon schedules excision of the fractured sesamoid under regional block or general anesthesia in an outpatient ambulatory surgery center. The procedure involves a small incision over the sesamoid, careful dissection to protect the digital nerves and flexor apparatus, excision of the sesamoid, irrigation, hemostasis, and layered closure. Postoperative care includes short-term immobilization in a thumb spica splint, wound checks, pain management, and hand therapy as indicated to restore range of motion and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the excision is performed on the left thumb or finger sesamoid. |
RT | Right side | Use when the excision is performed on the right thumb or finger sesamoid. |