Summary & Overview
CPT 26352: Flexor Tendon Repair/Advancement with Free Graft, Delayed Reconstruction
CPT code 26352 covers delayed surgical repair or advancement of a flexor tendon in the hand or finger outside of zone 2 using a free graft. This code captures a specialized reconstructive procedure performed when primary repair at the time of injury is not undertaken or possible, and it is important for accurately coding complex hand surgery cases that affect function and rehabilitation needs. Nationally, correct use of this code supports appropriate clinical documentation, surgical billing, and payment for reconstructive hand services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of clinical context and coding purpose, payer coverage landscape, common modifiers and billing considerations, and related service-line implications. The publication outlines benchmarks for utilization and reimbursement patterns where available and flags common policy considerations payers apply to tendon reconstruction claims.
The analysis provides clinicians, coding professionals, and revenue staff with practical context for when CPT code 26352 applies, typical sites of service, and how this code fits within hand surgery service lines. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 26352 describes a surgical procedure in which the provider repairs or advances a flexor tendon of the hand or finger in an area other than zone 2 using a free graft. The procedure is performed as a delayed tendon reconstruction rather than at the time of the initial injury.
Service type: Surgical — tendon repair/reconstruction
Typical site of service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old right-hand-dominant construction worker presents six weeks after a partial laceration of the flexor tendon of the ring finger sustained when a glass shard penetrated the palmar surface. Initial wound care and delayed primary repair were not performed at the time of injury due to contamination and soft-tissue loss. The patient now has persistent loss of active flexion at the proximal interphalangeal and distal interphalangeal joints and a palpable tendon defect. Conservative therapy has failed to restore function. The hand surgeon schedules an elective operative procedure to reconstruct the flexor tendon in an area outside of flexor zone II using a free tendon graft (e.g., palmaris longus or toe extensor graft) and tenolysis as needed.
Preoperative workup includes focused hand and neurovascular exam, hand radiographs to exclude bony injury, and review of prior wound care. The operative workflow includes general or regional anesthesia, exploration of the tendon sheath, debridement of scar tissue, harvest of the tendon graft, graft placement with core and epitendinous sutures, possible pulley reconstruction, and postoperative hand therapy with splinting and staged mobilization. Typical site of service is an outpatient ambulatory surgery center or hospital outpatient department. This is not a repair performed at the time of initial injury and is performed in an area other than flexor zone II.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |