Summary & Overview
CPT 26755: Closed Treatment of Distal Phalangeal Fracture
CPT code 26755 represents the closed treatment (closed reduction) of a distal phalangeal fracture in a finger or thumb and covers manipulation or adjustment of the fractured bone without open surgical exposure. This code is commonly used across emergency departments, ambulatory surgical centers, hospital outpatient departments, and office-based procedural settings when clinicians perform non‑operative alignment of distal phalanx fractures. Nationally, appropriate use of this code affects billing for acute hand and finger trauma care and influences short-term episode costs and site-of-service distribution for minor orthopedic procedures.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and common service settings, payer coverage patterns and benchmarks where available, typical modifier usage and coding considerations, and related policy or billing updates that affect claim processing and reimbursement. The publication also highlights considerations for documentation that supports use of CPT code 26755, common procedural adjacencies, and how this code fits within broader hand fracture management coding. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 26755 describes a closed treatment of a distal phalangeal fracture of a finger or thumb, performed without open surgery. The procedure includes manipulation or adjustment of the fractured distal phalanx to restore alignment.
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Service type: Fracture management, closed reduction of distal phalanx
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Typical site of service: Ambulatory surgery center, hospital outpatient department, emergency department, or office-based procedural suite where minor hand procedures are performed
Clinical & Coding Specifications
Clinical Context
A patient presents to an urgent care or emergency department after sustaining a direct crush to the fingertip when a door closed on the hand. The patient reports localized pain, swelling, and visible deformity of the distal phalanx of the index finger. Plain radiographs confirm a displaced distal phalangeal fracture without open skin injury. The provider performs a closed reduction under digital or local anesthesia, manipulates the distal fragment into alignment, and applies a sterile dressing and protective splint or digital nail traction dressing as needed. Post-procedure care includes neurovascular checks, tetanus update if indicated, instructions for elevation and ice, analgesics, wound care guidance, and scheduling follow-up with hand surgery or orthopedics for repeat radiographs and potential further management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure was performed on the left finger or thumb |
RT | Right side | Use when the procedure was performed on the right finger or thumb |