Summary & Overview
CPT 26412: Extensor Tendon Repair with Free Graft, Hand
CPT code 26412 covers surgical repair of extensor tendons in the hand using a free tendon graft, performed to restore extension after laceration or rupture. The code differentiates timing of repair: primary repair when done within seven days of injury and secondary repair when performed later. Nationally, this code represents complex reconstructive hand surgery and factors into surgical billing, hospital resource use, and post-operative rehabilitation planning.
Key payers addressed in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of clinical context for extensor tendon grafting, typical sites of service (operating room or ambulatory surgical center), common billing modifiers associated with surgical services, and payer coverage patterns where available. The publication outlines benchmarks for utilization and reimbursement practices, highlights policy or coding guidance relevant to timing distinctions between primary and secondary repair, and summarizes implications for coding accuracy and claim adjudication. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 26412 describes extensor tendon repair with free tendon graft in the hand. The procedure addresses laceration or rupture of one or more extensor tendons that results in loss of normal hand movements. The code covers both primary repairs (performed within seven days of injury) and secondary repairs (performed more than seven days after injury when immediate repair was not possible).
Service Type: Surgical repair of extensor tendons with free graft
Typical Site of Service: Operating room or ambulatory surgical center, typically billed when a surgeon performs reconstructive tendon surgery in a procedural setting required for microsurgical repair and grafting.
Clinical & Coding Specifications
Clinical Context
A 34-year-old right-hand dominant construction worker presents to the emergency department after sustaining a deep laceration to the dorsum of the right hand from a falling piece of metal. On exam there is loss of active finger extension at the proximal interphalangeal joint of the ring and small fingers with visible tendon ends and an open wound. The patient is taken to the operating room for surgical exploration and repair. Because the repair occurs more than seven days after the documented date of injury due to initial wound care and delayed referral, the operative repair is performed as a secondary extensor tendon repair using a free tendon graft to restore continuity and function.
The clinical workflow includes preoperative assessment and imaging as needed, informed consent detailing risks and expected outcomes, general or regional anesthesia, surgical exposure of the extensor tendon defects, harvest and preparation of a free tendon graft (commonly palmaris longus or plantaris when available), graft interposition and securement with appropriate suture technique, layered closure of the wound, application of protective immobilization or dorsal splinting, and postoperative hand therapy with staged mobilization and routine follow-up to monitor tendon healing and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When another procedure on the same day is distinct and not normally billed together with the tendon repair (to indicate a separate service). |