CPT 26372: Secondary Repair of Finger Flexor Profundus Tendon with Free Graft
CPT code 26372 denotes a secondary surgical procedure to repair the flexor profundus tendon in a finger using a free graft while leaving the flexor superficialis intact. This procedure is clinically significant because tendon reconstructions performed after initial injury or failed primary repair present increased technical complexity, rehabilitation needs, and potential cost implications compared with primary repairs. Nationally, accurate coding of secondary tendon repair affects payment, quality tracking, and surgical outcome reporting across surgical and hand-specialty practices.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how these payers commonly classify and reimburse complex hand surgery CPT codes, and it highlights considerations relevant to facility and professional billing, postoperative care, and rehabilitation service lines.
Readers will find: concise clinical context for CPT code 26372; typical sites of service and service type; common billing modifiers and administrative notes where data is available; and a high-level view of payer coverage patterns and documentation expectations. When specific data elements were not provided in the input, the text indicates that those items are not available. This overview is intended for clinicians, coding professionals, and policy analysts seeking a clear, national-level reference for secondary profundus tendon repair coding.
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Billing Code Overview
CPT code 26372 describes a secondary repair of the profundus tendon of a finger using a free graft, performed while preserving the superficialis tendon. Secondary repair indicates the procedure is done at least several days after the initial injury or a prior surgical repair.
Service type: Surgical repair of finger flexor tendon (secondary, with free grafting of profundus)
Typical site of service: Ambulatory surgical center or hospital operating room, depending on clinical complexity and patient needs.
Clinical & Coding Specifications
Clinical Context
A 32-year-old right-hand dominant construction worker presents three months after a zone I flexor tendon laceration of the ring finger that was initially managed with primary repair but developed adhesions and persistent loss of distal interphalangeal joint flexion. The patient reports diminished grip strength and inability to actively flex the fingertip. Examination shows intact flexor digitorum superficialis (FDS) function with absent or dysfunctional flexor digitorum profundus (FDP) excursion. Imaging and dynamic ultrasound confirm a failed primary FDP repair with tethering and tendon gap unsuitable for direct repair.
The hand surgeon schedules a secondary repair of the profundus tendon using a free tendon graft (e.g., palmaris longus or plantaris) while preserving the superficialis tendon. The procedure is performed in an ambulatory surgery center under regional block with monitored anesthesia care. Intraoperative steps include exposure of the tendon sheath, release of adhesions, measurement of the defect, harvest and preparation of the graft, distal and proximal tendon graft suturing (core and epitendinous repair), and balanced tensioning to restore DIP joint glide while keeping FDS intact. Postoperative care includes dorsal blocking orthosis, early controlled passive/active motion protocol under hand therapy supervision, wound checks, and staged strengthening once tendon healing permits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds typical for 26372 (document specifics). |
23 | Unusual anesthesia | Use when general anesthesia is required for an otherwise normally local/regional procedure (document reason). |
26 | Professional component | Use when reporting only the surgeon's professional component separate from facility technical component (rare for surgery). |
50 | Bilateral procedure | Use when identical procedure 26372 is performed on both hands/fingers during same operative session. |
51 | Multiple procedures | Use when 26372 is reported with other distinct procedures at the same session (sequence/pegging rules apply). |
52 | Reduced services | Use when procedure is partially reduced or not completed as described. |
54 | Surgical care only | Use when only the surgical portion is billed and another provider bills pre/postoperative care. |
55 | Postoperative management only | Use when only post-op care is billed by a different provider. |
62 | Two surgeons | Use when two surgeons of different specialties participate and both bill for distinct portions of 26372. |
78 | Unplanned return to OR | Use when a return to the operating room for related procedure occurs during the global period. |
80 | Assistant surgeon | Use when an assistant at surgery (unspecified) is involved and allowed by payor policy. |
81 | Minimum assistant surgeon | Use when a minimal assistant surgeon role is documented and permitted. |
82 | Assistant not available | Use when a qualified resident performs the assistant role and a surgeon is not available. |
LT | Left side | Use to designate the left finger when laterality is required. |
RT | Right side | Use to designate the right finger when laterality is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Orthopedic Hand Surgery | Primary specialty performing complex flexor tendon reconstruction and grafting. |
| 207T00000X | Plastic Surgery-Hand | Common specialty performing reconstructive tendon repairs in the hand. |
| 207K00000X | General Orthopedic Surgery | Orthopedic surgeons who perform hand and wrist tendon reconstructions. |
| 208U00000X | Occupational/Hand Therapy | Not a surgical provider taxonomy but integral for postoperative rehabilitation (billing therapy services separately). |
| 208000000X | Family Medicine (with surgical capability) | Rare but may appear in limited settings; include only if credentialed for hand procedures. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S66.321A | Laceration of flexor tendon of right little finger at wrist and hand level, initial encounter | Flexor tendon lacerations are the typical injury leading to secondary FDP repair when primary repair fails. |
S66.322A | Laceration of flexor tendon of left little finger at wrist and hand level, initial encounter | Same as above for the left side; laterality guides billing with LT/RT modifiers. |
M24.2 | Disorder of ligament, unspecified | Can be used when joint instability or soft tissue disorder contributes to tendon dysfunction requiring repair. |
M67.4 | Tenosynovitis, unspecified | Chronic tenosynovitis with adhesions can necessitate secondary tendon reconstruction with graft. |
T79.A1 | Traumatic arthropathy, initial encounter | Post-traumatic changes complicating tendon repair and requiring reconstructive procedures. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26055 | Repair, flexor tendon, primary or secondary, forearm and/or wrist, each tendon | May be used for more proximal flexor tendon repairs when injury extends into the forearm/wrist region in the same patient. |
26160 | Repair, flexor tendon, each tendon, hand and/or finger, primary repair | Represents primary repair codes; useful for comparison when initial primary repair was performed earlier. |
26440 | Tendon sheath incision (tenolysis), finger or thumb | Performed when tenolysis of adhesions is required; may be performed in conjunction with or separate from grafting procedures. |
20930 | Tendon graft, single strand, hand/foot, includes obtaining graft | May be used when reporting free tendon grafting separate from repair technique; relates to graft harvest and preparation. |
29515 | Application of short arm cast (below elbow) | Common postoperative immobilization performed immediately after 26372 before orthosis and therapy. |