How To Use CPT Code 26358

CPT 26358 describes the repair or advancement of a flexor tendon in the zone 2 digital flexor tendon sheath, specifically in the area known as “no man’s land.” This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26358?

CPT 26358 is used to describe the repair or advancement of a flexor tendon in the zone 2 digital flexor tendon sheath, specifically in the area known as “no man’s land.” This code is used when a provider incorporates a free graft to complete the repair of the injured tendon. The procedure aims to restore function and relieve pain in the affected finger.

2. Official Description

The official description of CPT code 26358 is: ‘Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man’s land); secondary, with free graft (includes obtaining graft), each tendon.’

3. Procedure

1. The provider begins by making a zigzag, volar digital incision over the skin of the palm and finger to access the tendons.
2. Special care is taken to prevent damage to the pulleys, which are structures that hold the tendons close to the bone, and to preserve the tendon sheath as much as possible.
3. Any ragged edges on the tendon are excised, or removed.
4. If a graft is needed to complete the repair, the provider harvests the graft from another tendon in the hand, such as the palmaris longus tendon.
5. The graft is then placed into position and the superficial flexor tendon is sutured with horizontal mattress stitches or the deep flexor tendon is sutured with simple running stitches.
6. After controlling any bleeding, the provider removes all instruments and closes the surgical wound in layers.

4. Qualifying circumstances

CPT 26358 is used for the repair or advancement of a flexor tendon in the zone 2 digital flexor tendon sheath, specifically in the area known as “no man’s land.” This procedure is performed when a free graft is incorporated to complete the repair of the injured tendon. It is typically used for severely lacerated tendons with ragged edges.

5. When to use CPT code 26358

CPT code 26358 should be used when a provider performs a secondary repair of a flexor tendon in the zone 2 digital flexor tendon sheath, specifically in the area known as “no man’s land,” and incorporates a free graft to complete the repair. This code should not be used for primary repairs performed within the first seven days after the injury or for secondary repairs performed more than seven days after the injury without a free graft.

6. Documentation requirements

To support a claim for CPT 26358, the provider must document the following information:

• Patient’s diagnosis and the need for the repair or advancement of the flexor tendon
• Details of the procedure, including the use of a free graft and the specific tendon from which it was harvested
• Date of the procedure
• Any additional information relevant to the specific case
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 26358, ensure that the procedure meets the criteria for a secondary repair of a flexor tendon in the zone 2 digital flexor tendon sheath with a free graft. Follow your payer’s reporting requirements to determine whether to report 26358 as a single line item with two units of service or as two line items with modifier 59. Additionally, use the appropriate finger modifiers (FA through F9) to identify the specific finger on which the procedure was performed.

8. Historical information

CPT 26358 was added to the Current Procedural Terminology system on January 1, 1990. There have been two code changes since its addition, with the most recent change occurring on January 1, 2004.

9. Examples

1. A provider performs a secondary repair of a flexor tendon in the zone 2 digital flexor tendon sheath with a free graft on the index finger of the left hand.
2. A patient sustains a severe laceration to the ring finger of the right hand, requiring a secondary repair of the flexor tendon in the zone 2 digital flexor tendon sheath with a free graft.
3. A provider incorporates a free graft to complete the repair of a severely lacerated flexor tendon in the zone 2 digital flexor tendon sheath on the thumb of the right hand.
4. A patient undergoes a secondary repair of a flexor tendon in the zone 2 digital flexor tendon sheath with a free graft on the middle finger of the left hand.
5. A provider performs a secondary repair of a flexor tendon in the zone 2 digital flexor tendon sheath with a free graft on the little finger of the right hand.
6. A patient requires a secondary repair of a flexor tendon in the zone 2 digital flexor tendon sheath with a free graft on the index finger of the right hand.
7. A provider incorporates a free graft to complete the repair of a severely lacerated flexor tendon in the zone 2 digital flexor tendon sheath on the ring finger of the left hand.