How To Use CPT Code 26755

CPT 26755 describes the closed treatment of a distal phalangeal fracture in a finger or thumb, including manipulation, if necessary. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 26755?

CPT 26755 is used to describe the closed treatment of a distal phalangeal fracture in a finger or thumb. This procedure involves manipulating the fractured bone to realign it and then placing the patient’s digit in a brace or splint for approximately four weeks. The provider may also perform an X-ray to confirm the reduction of the fracture.

2. Official Description

The official description of CPT code 26755 is: ‘Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each.’

3. Procedure

1. The provider begins by examining the fractured bone using an X-ray.
2. If necessary, the provider manually adjusts the fractured fragment by applying a pushing or pulling force to the phalanx, realigning the bones.
3. After the manipulation, the provider immobilizes the digit by placing it in a brace or splint.
4. The patient is instructed to wear the brace or splint for approximately four weeks to allow for proper healing.
5. If needed, the provider may perform follow-up X-rays to ensure the fracture remains properly aligned.

4. Qualifying circumstances

CPT 26755 is used for patients who have a distal phalangeal fracture in a finger or thumb that requires closed treatment with manipulation. This code is appropriate when the provider manually adjusts the fractured bone to realign it. It is important to note that this code should not be used if the provider performs percutaneous skeletal fixation or open treatment with internal fixation implants.

5. When to use CPT code 26755

CPT code 26755 should be used when a patient has a distal phalangeal fracture in a finger or thumb that requires closed treatment with manipulation. This code is not appropriate if the provider does not perform manipulation or if they use percutaneous skeletal fixation or open treatment with internal fixation implants.

6. Documentation requirements

To support a claim for CPT code 26755, the provider must document the following information:

• Diagnosis of a distal phalangeal fracture in a finger or thumb
• Details of the manipulation performed, including the method used
• Date of the procedure
• Documentation of the brace or splint applied
• Instructions given to the patient regarding wearing the brace or splint
• Any follow-up X-rays performed

7. Billing guidelines

When billing for CPT code 26755, ensure that the procedure performed meets the criteria for closed treatment with manipulation of a distal phalangeal fracture in a finger or thumb. This code should not be reported if percutaneous skeletal fixation or open treatment with internal fixation implants are performed. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT code 26755 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with a distal phalangeal fracture in their thumb. The provider performs closed treatment with manipulation, realigning the fractured bone and placing the thumb in a splint for four weeks.
2. A patient sustains a distal phalangeal fracture in their index finger. The provider performs closed treatment with manipulation, adjusting the fractured bone and applying a brace to immobilize the finger during the healing process.
3. A patient fractures their pinky finger distal phalanx. The provider performs closed treatment with manipulation, manipulating the fractured bone and instructing the patient to wear a splint for four weeks to promote proper healing.
4. A patient presents with a distal phalangeal fracture in their middle finger. The provider performs closed treatment with manipulation, realigning the fractured bone and placing the finger in a brace to support the healing process.
5. A patient sustains a distal phalangeal fracture in their ring finger. The provider performs closed treatment with manipulation, adjusting the fractured bone and applying a splint to immobilize the finger for approximately four weeks.
6. A patient fractures their thumb distal phalanx. The provider performs closed treatment with manipulation, manipulating the fractured bone and instructing the patient to wear a brace to support the healing process.
7. A patient presents with a distal phalangeal fracture in their index finger. The provider performs closed treatment with manipulation, realigning the fractured bone and placing the finger in a splint for four weeks.
8. A patient sustains a distal phalangeal fracture in their middle finger. The provider performs closed treatment with manipulation, adjusting the fractured bone and applying a brace to immobilize the finger during the healing process.
9. A patient fractures their pinky finger distal phalanx. The provider performs closed treatment with manipulation, manipulating the fractured bone and instructing the patient to wear a splint for four weeks to promote proper healing.
10. A patient presents with a distal phalangeal fracture in their thumb. The provider performs closed treatment with manipulation, realigning the fractured bone and placing the thumb in a brace to support the healing process.