Summary & Overview
CPT 26735: Open Treatment of Phalangeal Shaft Fracture
CPT code 26735 identifies open surgical treatment of a phalangeal shaft fracture in the proximal or middle phalanx of a finger or thumb, generally performed with internal fixation (pins, wires, or screws). This code is used across inpatient and outpatient surgical settings and is relevant to hand surgery, orthopedics, and trauma care. Nationally, accurate reporting of 26735 impacts surgical quality measurement, resource use accounting, and payer contracting for hand fracture management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical framing of the procedure, typical sites of service, common payer considerations, and an overview of billing factors that influence reimbursement and utilization reporting. The discussion highlights how 26735 is used in claims to represent open fixation of proximal or middle phalanx shaft fractures and what stakeholders should expect in terms of coding context.
This summary prepares clinicians, coders, and policy analysts to interpret claims carrying CPT code 26735, understand where the procedure is commonly performed, and identify the primary topics addressed in the full publication, including benchmark comparisons, billing nuances, and policy or coverage considerations. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 26735 describes an open treatment of a phalangeal shaft fracture of a finger or thumb, involving the proximal or middle phalanx. The procedure typically includes exposure of the fracture site and internal fixation using implants such as pins, wires, or screws to restore alignment and stability.
Service Type: Surgical — Open fracture fixation of a phalanx
Typical Site of Service: Ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 34-year-old right-hand-dominant construction worker presents to the emergency department after a crush injury to the left ring finger. Imaging demonstrates a displaced transverse mid-shaft fracture of the proximal phalanx with rotational deformity and joint incongruity. The orthopedic hand surgeon schedules an open reduction and internal fixation to restore alignment, rotation, and stability.
The typical clinical workflow includes preoperative evaluation with focused hand exam and neurovascular assessment, radiographs (AP, lateral, oblique), informed consent, and optimization for anesthesia (regional block or general). In the operating room, the surgeon performs an open approach to the fracture, achieves reduction, and applies internal fixation such as Kirschner wires, screws, or small plates. Postoperative care includes wound care, splinting or protective orthosis, pain control, and early hand therapy for range of motion as indicated. Follow-up radiographs confirm healing and hardware position, and removal of percutaneous pins is scheduled if used.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left finger or thumb. |
RT |