CPT 26340: Manipulation of Finger Joint Under Anesthesia
CPT code 26340 covers manipulation of a finger joint performed under anesthesia, involving passive movements and stretching to restore or improve joint mobility. Nationally, this code is relevant to hand surgeons, orthopedic specialists, and ambulatory surgical facilities that manage stiffness, contractures, or post-traumatic finger joint dysfunction. Proper coding affects claims processing, anesthesia billing, and site-of-service determination. Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for utilization patterns, payer coverage considerations, and clinical context for when manipulation under anesthesia is billed for finger joints. The summary outlines procedural indications, typical settings where the service is delivered, and the billing implications clinicians and billing staff should track. Data not available in the input is noted where applicable; the publication does not offer clinical recommendations but summarizes coding intent, common billing modifiers listed for administrative use, and areas where payers commonly apply medical necessity review.
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Billing Code Overview
CPT code 26340 describes a procedure in which the provider performs manipulation of a finger joint under anesthesia, consisting of passive movements and stretching of the joint. This service is typically categorized as a minor surgical or procedural intervention involving joint manipulation to restore or improve range of motion.
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Service type: Procedural manipulation of a finger joint under anesthesia
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an office setting with appropriate anesthesia and monitoring
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an outpatient orthopedics clinic with progressive stiffness and pain of the proximal interphalangeal joint of the right index finger following a distal radius fracture treated conservatively three months earlier. Conservative care including splinting, NSAIDs, and home range-of-motion exercises produced limited improvement. The hand surgeon schedules a manipulation of the finger joint under anesthesia to break adhesions and improve passive range of motion. On the day of service, the patient undergoes pre-procedure evaluation, informed consent, and a short-acting regional block in the procedure suite. Under monitored anesthesia care, the surgeon performs gentle, controlled passive movements and stretching of the affected finger joint until improved excursion is achieved. The joint is reassessed for stability and neurovascular status, and a soft dressing or splint is applied. The typical site of service is an ambulatory surgery center or hospital outpatient department, though this procedure can be performed in an office-based procedure room equipped for sedation and anesthesia. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, default professional service | Use when the procedure is performed as reported without any unusual circumstances. |
22 | Increased procedural services | Use when work required to perform the manipulation is substantially greater than typical. |
23 | Unusual anesthesia | Use when general anesthesia is necessary for reasons distinct from the procedure itself. |
26 | Professional component | Use if reporting only the physician component separate from technical services (rare for this code). |
50 | Bilateral procedure | Use when identical manipulation is performed bilaterally on matching digits and payer allows bilateral reporting. |
51 | Multiple procedures | Use when multiple distinct procedures are reported on the same day in addition to this manipulation. |
52 | Reduced services | Use when the procedure was partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure was started but terminated due to extenuating circumstances prior to completion. |
59 | Distinct procedural service | Use when another service on the same day is distinct and not typically reported together; supports separate billing. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the manipulation. |
76 | Repeat procedure by same physician | Use if the same physician repeats the manipulation during the same encounter (Note: Not in provided list; excluded). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Orthopaedic Surgery | Hand and upper extremity surgeries including joint manipulations. |
| 207XS0102X | Plastic Surgery | Reconstructive hand surgeons who perform manipulations for stiffness after trauma or surgery. |
| 2080P0207X | Anesthesiology | Provides regional or general anesthesia for the procedure. |
| 207L00000X | General Surgery | Occasionally performs minor hand procedures in some settings. |
| 363LF0000X | Physical Therapy | Provides pre- and post-procedure therapy but does not bill CPT 26340 (listed for clinical context). |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M24.21 | Stiffness of right finger | Direct indication for manipulation to improve passive range of motion. |
M24.22 | Stiffness of left finger | Indicates finger joint stiffness potentially treated with manipulation. |
M67.431 | Trigger finger, right index finger | May coexist with joint contracture; manipulation can be part of management after anesthesia. |
M25.511 | Pain in right wrist | Pain in adjacent joints may prompt manipulation of finger joints as part of overall care. |
S62.501A | Unspecified fracture of right phalanx, initial encounter for closed fracture | Post-fracture stiffness leading to joint manipulation during recovery. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20600 | Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., interphalangeal) | May be performed before manipulation to aspirate hemarthrosis or inject corticosteroid for inflammation. |
27096 | Application of a short arm splint; forearm and wrist (Note: code for splinting of adjacent areas) | Splinting or immobilization applied immediately after manipulation to maintain improved range of motion. |
97035 | Ultrasound therapy, each 15 minutes; therapeutic | Used as part of post-procedure therapy to reduce stiffness and encourage tissue mobility. |
97110 | Therapeutic exercises to develop strength, endurance, range of motion and flexibility | Commonly performed in outpatient therapy following manipulation to preserve gains in range of motion. |
20820 | Injection of therapeutic agent; tendon sheath (e.g., for trigger finger) | Performed when a concurrent tendon sheath condition is treated in the same session or separately. |