CPT 26356: Repair of Flexor Tendon of Finger
CPT code 26356 designates surgical repair of a flexor tendon injury in a finger, a procedure aimed at restoring range of motion and alleviating pain after tendon laceration or trauma. Nationally, this code is relevant to orthopedic and hand surgeons, surgical facilities, and payers managing post-injury surgical care and rehabilitation. It is used to document operative management of finger flexor tendon injuries and supports billing for the surgical service and facility resources required.
Key payers discussed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find comparative benchmarks and coverage considerations across major national payers, clinical context for when the procedure is typically performed, and operational details such as common sites of service. The publication outlines typical utilization patterns, coding considerations tied to operative repair of finger flexor tendons, and informs administrative and clinical stakeholders about payment and policy themes affecting this procedure. Data not available in the input is noted where relevant.
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Billing Code Overview
CPT code 26356 describes surgical repair of an injury to a finger flexor tendon, such as a laceration, performed to restore tendon function and relieve pain. This procedure involves direct repair of a damaged flexor tendon in one of the fingers.
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Service type: Surgical tendon repair
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Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 32-year-old right-hand–dominant construction worker presents to the emergency department after a work-related laceration to the volar aspect of the ring finger. Physical exam demonstrates an open wound with inability to actively flex the distal interphalangeal joint, suggesting a flexor digitorum profundus tendon laceration. Neurovascular status is intact. Radiographs show no fracture. The patient is counseled and scheduled for operative primary repair of the flexor tendon under regional block in an ambulatory surgical center.
The clinical workflow includes preoperative evaluation (history, tetanus status, consent), operative repair of the injured flexor tendon (26356) under sterile conditions with appropriate anesthesia, intraoperative documentation of tendon ends, suture technique, and any core/epitendinous repairs. Postoperative plan includes immobilization in a dorsal blocking splint, referral to hand therapy for early controlled mobilization protocols, wound care instructions, pain control, and scheduled follow-up visits for suture removal and rehabilitation monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the repaired finger is on the left hand |
RT | Right side | When the repaired finger is on the right hand |
GA | Data not available in the input. | Data not available in the input. |
59 | Distinct procedural service | When a separate, distinct procedure is performed on the same day (e.g., separate repair on a different finger) |
52 | Reduced services | When the procedure is partially reduced or not completed as described |
53 | Discontinued procedure | When the procedure is started but aborted due to extenuating circumstances |
22 | Increased procedural services | For unusually complex repair requiring substantially greater work than typical |
51 | Multiple procedures | When multiple procedures are performed at the same session (used in conjunction with primary procedure reporting rules) |
76 | Repeat procedure by same physician | When a subsequent repair is performed by the same surgeon during the postoperative period |
77 | Repeat procedure by another physician | When a subsequent repair is performed by another surgeon during the postoperative period |
78 | Unplanned return to the operating room for a related procedure during the global period | For surgical revision or management of complication related to the initial repair |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed during the global period |
52 | Reduced services | When circumstances reduce the standard components of the service (duplicate entry removed if already listed) |
26 | Professional component | When billing only the professional component separate from technical (rare for surgical procedures) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
| 261QA0400X | Plastic Surgery | Surgeons who commonly perform hand and tendon repairs |
| 207L00000X | Orthopedic Surgery | Orthopedic hand surgeons performing tendon repairs |
| 207P00000X | General Surgery | General surgeons with hand surgery training may perform repairs |
| 2080P0208X | Physical Therapy | Hand therapists providing postoperative rehabilitation |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S66.321A | Laceration of flexor muscle, fascia and tendon of right little finger at forearm level, initial encounter | Flexor tendon laceration is a direct indication for primary repair such as 26356 |
S66.322A | Laceration of flexor muscle, fascia and tendon of left little finger at forearm level, initial encounter | Same relevance for left-sided injuries requiring repair |
S61.341A | Laceration without foreign body of flexor tendon of right index finger, initial encounter | Digital flexor tendon laceration commonly billed with tendon repair code |
S61.342A | Laceration without foreign body of flexor tendon of left index finger, initial encounter | Left-sided digital flexor tendon laceration indication |
S61.351A | Laceration without foreign body of flexor tendon of right middle finger, initial encounter | Clinical scenario for 26356 when middle finger involved |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26055 | Tendon sheath excision (e.g., tenolysis) | May be performed if adhesions or delayed presentation require tenolysis alongside or after primary repair |
26160 | Repair, tendon, flexor, forearm and/or wrist; single tendon | Related when proximal flexor tendon injuries at the wrist/forearm require repair instead of a digital repair |
26440 | Repair, tendon, extensor, finger or thumb, primary or secondary; without free graft, each tendon | Extensor tendon counterpart; may be billed if extensor tendon repair is performed concurrently |
29840 | Arthroscopy, wrist, diagnostic, with or without synovial biopsy | May be used if intra-articular evaluation is necessary for associated joint injury |
12001 | Simple repair of superficial wound (e.g., laceration) | Used when associated superficial skin laceration repair is performed in addition to tendon repair |