Summary & Overview
CPT 26545: Collateral Ligament Repair of Finger with Graft
CPT code 26545 denotes surgical reconstruction of a collateral ligament of a finger joint using a tendon or fascial graft. This code captures a specialized hand surgery procedure intended to restore joint stability and function after significant ligament injury. Nationally, accurate coding for this procedure affects claims adjudication, surgical quality tracking, and payment for specialized hand and orthopedic services. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical context for the procedure, common sites of service, and the role of CPT code 26545 in surgical hand care. The publication summarizes typical payer coverage considerations, usual billing modifiers, and common documentation elements that support medical necessity. It also provides benchmarks and policy updates relevant to surgical reconstruction of finger collateral ligaments, and discusses implications for coding accuracy and claims processing in outpatient and inpatient surgical settings. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 26545 describes surgical repair of a collateral ligament of a finger joint (between two phalanges) using a tendon or fascial graft to replace the damaged portion. This procedure addresses instability or functional loss from a torn or deficient collateral ligament.
-
Service type: Surgical ligament reconstruction of the finger (collateral ligament repair with graft)
-
Typical site of service: Ambulatory surgery center or hospital operating room for hand surgery; procedure is performed by orthopedic or hand surgery specialists.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 32-year-old right-hand-dominant construction worker presenting with acute radial-sided index finger pain and instability after a forceful lateral stress injury during a fall. Examination reveals laxity and tenderness along the ulnar collateral ligament of the proximal interphalangeal joint with decreased pinch strength and difficulty gripping tools. Imaging (plain radiographs and a focused ultrasound or MRI) confirms a torn collateral ligament with retraction and attenuated native tissue unsuitable for simple repair.
The clinical workflow includes preoperative evaluation by a hand surgeon (history, focused hand exam, and imaging), preoperative consent discussing graft use (tendon or fascial graft), scheduling in an ambulatory surgery center or hospital operating room, performance of 26545 under regional or general anesthesia with use of an autograft or allograft to reconstruct the collateral ligament, immediate postoperative splinting, and planned hand therapy for range of motion and strengthening over several weeks to months. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for authorization and claims processing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left finger |