Summary & Overview
CPT 26235: Partial Excision of Proximal or Middle Phalanx of Finger
CPT code 26235 denotes a surgical procedure for partial excision of the proximal or middle phalanx of a finger, using techniques such as craterization, saucerization, or diaphysectomy. This code captures targeted osseous procedures on small bones of the hand and is relevant to orthopedic and hand surgery practices nationally due to the frequency of traumatic, infectious, and degenerative conditions affecting phalangeal bone.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent for the code, typical sites of service, and payer coverage context. The publication outlines common billing considerations, relevant modifiers provided in the input, and where this procedure fits within hand surgery service lines. It also summarizes benchmarks and policy-focused topics that affect reimbursement and coding consistency across major payers.
This summary serves clinicians, coding professionals, and policy analysts seeking a national perspective on the clinical definition, billing context, and administrative considerations associated with CPT code 26235. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 26235 describes a surgical procedure in which a provider partially excises a portion of the proximal or middle phalanx of a finger. Techniques referenced in the description include craterization, saucerization, or diaphysectomy, which indicate removal of bone tissue to address focal lesions or pathology affecting the phalanx.
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Service type: Surgical bone procedure on a finger phalanx (partial excision of phalanx)
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Typical site of service: Hospital outpatient department, ambulatory surgery center, or outpatient surgical clinic where hand and orthopedic procedures are performed
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old right-hand–dominant patient presents to an outpatient hand surgery clinic with chronic pain and focal bony enlargement of the distal aspect of the proximal phalanx of the index finger following prior trauma and persistent symptomatic exostosis. Conservative care including splinting and corticosteroid injections provided incomplete relief. On examination there is point tenderness, limited flexion at the proximal interphalangeal joint, and radiographs confirming a symptomatic osteophyte or bony prominence of the proximal phalanx.
The clinical workflow includes preoperative evaluation in clinic, informed consent specific to partial phalanx excision, preoperative hand marking and surgical planning, anesthesia assessment (local block with sedation or regional block), intraoperative partial excision of the proximal phalanx using techniques such as craterization or saucerization (CPT 26235), hemostasis, and soft-tissue repair. Postoperative care includes dressing and splinting, instruction on wound care, pain control, early range-of-motion therapy with occupational therapy as needed, and follow-up visits for wound check and assessment of function and pain.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or intensity substantially exceeds typical for . Documentation must support increased effort. |