How To Use CPT Code 26357

CPT 26357 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 26357, 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 26357?

CPT 26357 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 alleviate pain in the affected finger. It is important to note that CPT 26357 specifically refers to a secondary repair without the use of a free graft, and each tendon repaired should be reported separately.

2. Official Description

The official description of CPT code 26357 is: ‘Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man’s land); secondary, without free graft, each tendon.’

3. Procedure

1. The provider begins by preparing 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. Care is taken to avoid damage to the pulleys.
4. The provider repairs the laceration of the superficial flexor tendon using horizontal mattress sutures.
5. If the deep flexor tendon is also lacerated, the provider uses simple running stitches to repair it.
6. Bleeding is controlled, instruments are removed, and the surgical wound is closed in layers.

4. Qualifying circumstances

CPT 26357 is used for a secondary repair of a single digital flexor tendon without the use of a free graft. This procedure is typically performed more than seven days after the initial injury. It is important to follow the payer’s reporting requirements and use the appropriate finger modifiers (FA through F9) to identify the specific finger involved in the procedure.

5. When to use CPT code 26357

CPT code 26357 should be used when a secondary repair of a single digital flexor tendon is performed without the use of a free graft. This code is appropriate when the procedure is done more than seven days after the initial injury. If a primary repair without a free graft is performed within the first seven days, CPT code 26356 should be used instead.

6. Documentation requirements

To support a claim for CPT code 26357, the provider must document the following information:

• The diagnosis and indication for the secondary repair
• The specific finger involved in the procedure (using the appropriate finger modifier)
• The date of the procedure
• A detailed description of the repair technique used
• Any additional procedures performed during the same session
• The provider’s signature

7. Billing guidelines

When billing for CPT code 26357, it is important to ensure that the procedure meets the criteria for a secondary repair without a free graft. Follow the payer’s guidelines for reporting, which may include reporting two units of service or using modifier 59 when reporting multiple line items. Additionally, use the appropriate finger modifiers (FA through F9) to indicate the specific finger involved in the procedure.

8. Historical information

CPT code 26357 has undergone several changes throughout its history:

• 01-01-2004: The code description was changed to specify ‘secondary, each tendon’.
• 01-01-2002: The code description was changed to specify ‘secondary, each tendon’.
• 01-01-1990: CPT code 26357 was added to the Current Procedural Terminology system.

9. Examples

1. A patient undergoes a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of their left thumb.
2. A provider performs a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s right index finger.
3. A secondary repair is done on the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s left middle finger.
4. The provider performs a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s right ring finger.
5. A patient undergoes a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of their left little finger.
6. A provider performs a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s right thumb.
7. A secondary repair is done on the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s left index finger.
8. The provider performs a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s right middle finger.
9. A patient undergoes a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of their left ring finger.
10. A provider performs a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath of the patient’s right little finger.