Summary & Overview
CPT 26535: Interphalangeal Joint Reconstruction or Replacement
CPT code 26535 represents surgical reconstruction or replacement of interphalangeal joints using adjoining tissues to correct deformity, reduce inflammation, and restore function. This procedure is clinically important for patients with advanced arthritis or post-traumatic joint damage in the fingers or toes. Nationally, procedures coded with 26535 affect hand and foot surgery service lines and inform hospital and ambulatory surgery center resource planning, perioperative care pathways, and specialty-specific utilization trends.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context, typical sites of service, and procedural intent. The publication includes benchmarking information where available, payer coverage summaries, common modifiers associated with the code, and links to related procedural guidance and coding considerations. Clinical details clarify indications such as deformity correction, inflammatory reduction, and functional improvement, while billing-focused sections outline typical service settings and operational implications for surgical practices and facilities.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.
Billing Code Overview
CPT code 26535 describes surgical reconstruction or replacement of one or more interphalangeal joints using adjoining tissues. The procedure is performed to correct deformity, reduce inflammation, and improve function, typically for patients with arthritis or prior traumatic injury.
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Service type: Surgical joint reconstruction/replacement of interphalangeal joints
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Typical site of service: Ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 62-year-old right-hand-dominant female with a long-standing history of osteoarthritis and progressive pain, stiffness, and deformity of the left index finger proximal interphalangeal (PIP) joint presents to hand surgery clinic after failed conservative care (splinting, NSAIDs, corticosteroid injections). Radiographs demonstrate joint space loss, osteophyte formation, and subchondral sclerosis consistent with end-stage post‑traumatic/degenerative arthritis. The hand surgeon schedules operative reconstruction of the affected interphalangeal joint to relieve pain, correct deformity, and restore function.
Preoperative workflow includes focused history and hand-specific physical exam, informed consent documenting goals and risks of 26535 (interphalangeal joint reconstruction/replacement), medication reconciliation, imaging review, and optimization for anesthesia. On the day of surgery the patient receives regional block or general anesthesia in an ambulatory surgery center or hospital outpatient department. The surgeon performs 26535 using local soft-tissue flaps, tenodesis, capsular procedures, or implant-based joint reconstruction as indicated. Postoperative workflow includes immediate recovery monitoring, perioperative analgesia, hand immobilization in a splint, wound care instructions, and referral to hand therapy for range-of-motion and strengthening as clinically appropriate. Typical follow-up visits occur at 10–14 days for wound check, 4–6 weeks for early motion, and 3 months to assess functional outcomes.
Coding Specifications
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