Summary & Overview
CPT 26765: Open Treatment of Distal Phalangeal Fracture
CPT code 26765 represents open treatment of a distal phalangeal fracture of a finger or thumb with possible internal fixation using pins or screws. This operative code is central to hand and orthopedic surgical practice for managing unstable or displaced fractures of the distal phalanx that require direct reduction and fixation. Nationally, accurate coding of this procedure affects surgical quality reporting, reimbursement for operative hand care, and utilization tracking for trauma and elective hand surgery.
Key payers covered 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 an overview of common modifiers and billing considerations where available. The publication also outlines benchmarks for claim processing and payment patterns, updates to relevant coding guidance, and how CPT code 26765 is used alongside diagnosis codes in surgical hand care workflows.
This analysis is intended for revenue cycle professionals, hand and orthopedic surgical practices, and policy analysts seeking a national perspective on coding, billing, and operational implications of open distal phalangeal fracture repair in outpatient and inpatient surgical settings.
Billing Code Overview
CPT code 26765 describes an open treatment of a distal phalangeal fracture of a finger or thumb. The procedure involves surgical exposure of the fractured distal phalanx with reduction and stabilization, and may include internal fixation using pins or screws to secure bony fragments for healing.
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Service type: Surgical repair of a distal phalangeal fracture (open reduction and internal fixation)
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Typical site of service: Ambulatory surgery center or hospital operating room for hand surgery; occasionally performed in an urgent care surgical setting depending on facility capabilities
Clinical & Coding Specifications
Clinical Context
A 28-year-old right-hand-dominant male presents to the emergency department after a fall during recreational basketball. He reports acute pain, swelling, and deformity of the distal phalanx of the ring finger. Physical exam demonstrates focal tenderness at the fingertip, subungual hematoma, and limited distal interphalangeal joint motion. Plain radiographs confirm a displaced comminuted distal phalangeal fracture with nailbed involvement.
The clinical workflow begins with triage and analgesia, neurovascular and wound assessment, and tetanus status review. Digital block anesthesia and irrigation are performed for open wounds. If the fracture is unstable or open with nailbed injury, the hand surgeon schedules an open treatment of the distal phalangeal fracture with internal fixation (e.g., percutaneous K-wire or small-screw fixation) and nailbed repair as indicated. The procedure is typically performed in an outpatient ambulatory surgery center or hospital operating room under regional block, local anesthesia with sedation, or general anesthesia. Postoperative care includes wound and pin-site care instructions, short-term splinting or buddy taping, follow-up radiographs, and hand therapy referral if stiffness or tendon injury is present. Payer notifications and preauthorization may be completed prior to elective OR scheduling when required by the patient’s insurer.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |