Summary & Overview
CPT 26474: Tendon Fixation to Distal Interphalangeal Joint for Stability
CPT code 26474 denotes a targeted surgical intervention in which a provider affixes a tendon to the distal interphalangeal joint (the joint closest to the fingernail) to improve stability and function. This procedure is clinically important for patients with joint instability, deformity, traumatic injury, or chronic conditions impairing distal interphalangeal joint function. Nationally, accurate coding of this procedure supports appropriate surgical care documentation, claims processing, and outcome tracking for hand and finger reconstructive services.
Key payers relevant to national coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical sites of service, and the billing environment surrounding CPT code 26474. The publication outlines benchmarks and payer coverage considerations, highlights common billing modifiers and administrative items (where available), and situates the code within hand surgery service lines.
This summary serves clinicians, billing professionals, and policy analysts seeking a concise reference to CPT code 26474, clarifying what the code represents, why it matters in surgical hand care, and what to expect in payer interactions and administrative workflows. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 26474 describes a surgical procedure to affix a tendon to the distal interphalangeal joint, the finger joint nearest the fingernail, to improve joint stability. The service type is a surgical tendon fixation of a distal interphalangeal joint aimed at restoring or improving stability and function of the affected finger. The typical site of service is an outpatient surgical setting or ambulatory surgery center, or an inpatient operating room when clinically indicated.
Clinical & Coding Specifications
Clinical Context
A 46‑year‑old right‑hand‑dominant patient presents with chronic instability and pain of the distal interphalangeal (DIP) joint of the ring finger after a sports-related hyperextension injury six months earlier. Conservative measures including splinting, activity modification, and corticosteroid injection provided incomplete relief. On exam there is laxity of the terminal extensor mechanism, tenderness over the DIP joint, and functional limitation with decreased ability to extend the fingertip. Imaging (plain radiographs and ultrasound) excludes an acute fracture but demonstrates attenuation of the extensor tendon insertion.
Surgical workflow: The patient is consented for repair or reconstruction of the terminal extensor tendon insertion. In the ambulatory surgery center, a regional block and monitored anesthesia care are provided. A dorsal approach to the DIP joint is used; the torn or attenuated tendon is identified, debrided, and reattached to bone using suture anchor or transosseous sutures to restore terminal extension and joint stability. Sterile dressings and a protective splint are applied. Postoperative plan includes hand therapy with progressive range‑of‑motion and strengthening once tendon healing is adequate. Billing is submitted under 26474 for tendon affixation to the DIP joint.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |