How To Use CPT Code 26356

CPT 26356 describes a specific procedure for repairing or advancing the flexor tendon in the zone 2 digital flexor tendon sheath. This article will provide an overview of CPT code 26356, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26356?

CPT 26356 is a code used to describe a repair or advancement procedure performed on the flexor tendon in the zone 2 digital flexor tendon sheath. This procedure is typically done to restore function and relieve pain in patients who have suffered an injury, such as a laceration, to the flexor tendon of one of their fingers.

2. Official Description

The official description of CPT code 26356 is: ‘Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man’s land); primary, without free graft, each tendon.’

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. A zigzag, volar digital incision is made over the skin of the palm and finger to access the tendons.
3. The provider takes care to prevent damage to the pulleys.
4. If there is a laceration of the superficial flexor tendon, it is repaired using horizontal mattress sutures.
5. If the deep flexor tendon is also lacerated, the provider uses simple running stitches to repair it.
6. Any bleeding is controlled, and all instruments are removed.
7. The surgical wound is closed in layers.

4. Qualifying circumstances

CPT 26356 is used for primary repairs of a single digital flexor tendon without the use of a free graft. This code can be reported for each tendon repaired. The procedure is typically performed within the first 7 days after the injury.

5. When to use CPT code 26356

CPT code 26356 should be used when a provider performs a primary repair of a single digital flexor tendon without a free graft. It is important to follow the payer’s reporting requirements to determine whether to report 26356 as a single line item with two units of service or as two line items with modifier 59 as 26356, 26356 59. Finger modifiers FA through F9 should also be added as appropriate.

6. Documentation requirements

To support a claim for CPT 26356, the provider must document the following information:

• Patient’s diagnosis and the need for the flexor tendon repair
• Details of the procedure performed, including the specific tendons repaired
• Date of the procedure
• Any additional procedures or repairs performed
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26356, ensure that the procedure meets the criteria for a primary repair of a single digital flexor tendon without a free graft. Follow the payer’s guidelines for reporting and consider using modifier 59 if necessary. It is important to accurately report the finger modifiers FA through F9 to identify the specific finger on which the procedure was performed.

8. Historical information

CPT 26356 was added to the Current Procedural Terminology system on January 1, 1990. There have been a few changes to the code since its addition, including updates to the description and qualifying circumstances.

9. Examples

1. A patient sustains a laceration to the flexor tendon in their index finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
2. After a traumatic injury to the hand, a patient requires a repair of the flexor tendon in their middle finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
3. A patient presents with a laceration to the flexor tendon in their ring finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
4. Following an accident, a patient requires a repair of the flexor tendon in their little finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
5. A patient suffers a laceration to the flexor tendon in their thumb. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
6. After a workplace injury, a patient needs a repair of the flexor tendon in their index finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
7. A patient sustains a laceration to the flexor tendon in their middle finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
8. Following a sports-related injury, a patient requires a repair of the flexor tendon in their ring finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.
9. A patient presents with a laceration to the flexor tendon in their little finger. The provider performs a primary repair of the tendon without a free graft using CPT code 26356.