Summary & Overview
CPT 26236: Partial Excision of Distal Phalanx, Fingertip
CPT code 26236 captures a surgical procedure for partial excision of the distal phalanx of a finger, using techniques such as craterization, saucerization, or diaphysectomy. This code is used to report targeted removal of the bone at the fingertip for indications that may include chronic pain, infection, deformity, or failed conservative care. Nationally, accurate coding for partial distal phalanx excision is important for clinical documentation, inter-provider communication, and consistent claims processing across payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context and procedure setting, an outline of common modifiers and billing considerations where available, and benchmarks or policy-relevant items when present. The publication highlights expected sites of service (ambulatory surgical centers, hospital outpatient departments, and select office procedure rooms) and the procedural nature of the service line.
This summary equips clinicians, coding professionals, and policy analysts with a clear understanding of what CPT code 26236 represents, which payers commonly process claims for this service, and which operational and documentation areas typically matter for coding and reimbursement workflows. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 26236 describes a procedure in which the provider performs a partial excision of the distal phalanx of a finger. Techniques used can include craterization, saucerization, or diaphysectomy to remove a portion of the bone at the fingertip.
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Service type: Surgical procedure — partial distal phalanx excision
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Typical site of service: Ambulatory surgical center or hospital outpatient/operating room; may also be performed in an office procedure room depending on clinical circumstances and facility capabilities.
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Clinical & Coding Specifications
Clinical Context
A middle-aged adult presents to an outpatient hand clinic with chronic painful deformity and infection at the fingertip after recurrent paronychia and osteomyelitis of the distal phalanx. After conservative measures (oral antibiotics, local wound care, and nail plate removal) fail to resolve pain and drainage, the surgeon schedules a partial excision of the distal phalanx. The procedure is typically performed under regional or local anesthesia with or without monitored anesthesia care in an ambulatory surgical center or office-based procedure room. The workflow includes preoperative assessment (including reviewing imaging such as plain radiographs to assess bony involvement), informed consent, digital block anesthesia, sterile prep, partial excision/craterization of the distal phalanx with removal of necrotic bone and granulation tissue, hemostasis, and wound dressing. Postoperative care involves short-term oral antibiotics if infection present, tetanus update if indicated, pain control, wound surveillance, and hand therapy referral when required for mobility and functional recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater work than typical due to extensive debridement or prolonged operative time. |
23 |