Summary & Overview
CPT 26561: Surgical Separation of Congenitally Joined Fingers
CPT code 26561 represents surgical separation of congenitally joined fingers (syndactyly release) with repair using local skin flaps and possible skin grafting. This reconstructive hand surgery code is important nationally because it covers a procedure that restores hand form and function in pediatric and adult patients with congenital digit fusion, affecting long-term dexterity and quality of life. Reimbursement and coding clarity for this service affect surgical practice patterns, facility billing, and access to timely corrective care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and common billing considerations. The publication provides benchmarks and policy-relevant summaries, clinical context for coding and documentation, and an overview of modifiers commonly seen with operative procedures. The material is intended for coding specialists, surgical practices, and policy analysts seeking a national perspective on billing, coverage patterns, and administrative issues related to syndactyly release under CPT code 26561.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and payer-specific coverage rules.
Billing Code Overview
CPT code 26561 describes surgical separation of congenitally joined fingers (syndactyly release). The procedure involves incising between the webbed digits and repairing the resulting defect using local skin flaps created during division and, when needed, skin grafts.
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Service type: Surgical repair of congenital hand anomaly (syndactyly release)
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Typical site of service: Ambulatory surgery center or inpatient/outpatient hospital operating room, depending on patient age, complexity, and anesthesia needs.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child with congenital syndactyly presenting to a pediatric hand surgeon. The child has fused digits (partial or complete webbing) that limit independent finger motion, impede grasp, or threaten joint or nail growth. The clinical workflow begins with history and physical exam, including assessment of extent of webbing and any associated bony fusion. Preoperative planning includes imaging if bony involvement is suspected, discussion of anesthesia (general anesthesia is typical), and consent for surgical separation with local flap creation and possible skin grafting. In the operating room, the surgeon incises the web space, elevates and advances local skin flaps to reconstruct the interdigital web, and places full- or split-thickness skin grafts when local tissue is insufficient. Postoperative care includes dressing changes, short-term immobilization or splinting, pain control, wound checks, and hand therapy as indicated. Typical site of service is an ambulatory surgical center or hospital outpatient department. The service type is reconstructive hand surgery for congenital anomaly separation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider's standard service | Use for the usual, uncomplicated performance of the procedure when no other modifier applies. |
22 |