Summary & Overview
CPT 26546: Repair of Nonunion Deformity of Phalanx or Metacarpal
CPT code 26546 covers surgical repair of nonunion deformities in the phalanges or metacarpals of the hand, using bone grafting and fixation as needed to restore alignment and achieve union. This procedure addresses persistent non-healing fractures or deformities that impair hand function and can affect patient mobility, dexterity, and return to work. Nationally, proper coding and documentation of such reconstructive hand procedures are important for clinical tracking, quality measurement, and accurate reimbursement for complex operative care.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, the typical sites of service, and the service type. The publication also summarizes payer coverage considerations and common billing modifiers where available, presents benchmark comparators, and highlights relevant policy or documentation topics that influence claim adjudication. Where specific input data is not supplied, the text notes that those items are not available in the input.
This brief equips billing managers, surgical coders, and policy analysts with a clear understanding of what CPT code 26546 represents, why it matters in surgical and reimbursement workflows, and which topics to examine further when preparing or reviewing claims for nonunion reconstruction of the hand.
Billing Code Overview
CPT code 26546 describes surgical treatment of a nonunion deformity affecting a phalanx of the finger or a metacarpal bone of the hand. The procedure involves correction of the deformity, application of a bone graft, and use of fixation devices when needed to achieve union and restore alignment.
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Service type: Surgical reconstruction for nonunion deformity of the hand
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Typical site of service: Operating room or ambulatory surgery center, with perioperative care in a hospital or surgical facility
Data not available in the input for ICD-10 diagnoses, associated taxonomies, and related billing codes.
Clinical & Coding Specifications
Clinical Context
A 46-year-old right-handed construction worker presents with persistent pain, instability, and decreased range of motion of the index finger after a distal phalanx fracture treated conservatively 6 months prior. Imaging (plain radiographs and CT) demonstrates a symptomatic nonunion with malalignment of the phalanx. The treating hand surgeon schedules operative management: open excision of the nonunion site, autologous bone grafting (or structural graft as indicated), and internal fixation using a screw and/or plate to restore alignment and promote union. The clinical workflow includes preoperative evaluation (history, physical, neurovascular exam), imaging review, informed consent, optimization of medical comorbidities, perioperative antibiotic prophylaxis, procedure performed in an ambulatory surgery center or hospital outpatient operative suite under regional or general anesthesia, postoperative immobilization and wound care, and follow-up radiographs to document healing. Documentation elements required for coding include operative report describing site (phalanx or metacarpal), graft source, fixation method, laterality (LT/RT), medical necessity for addressing nonunion, and postoperative plan including rehabilitation referrals.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |