How To Use CPT Code 26765

CPT code 26765 describes the open treatment of a distal phalangeal fracture in a finger or thumb, including internal fixation if performed. 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 26765?

CPT 26765 can be used to describe the open treatment of a distal phalangeal fracture in a finger or thumb, including the use of internal fixation if necessary. This code is used when a healthcare provider performs a surgical procedure to treat a fracture in the distal phalanx of a finger or thumb, and may involve the use of implants such as pins or screws to stabilize the fracture.

2. Official Description

The official description of CPT code 26765 is: ‘Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure and administers anesthesia.
2. An incision is made over the fractured bone, and the provider carefully dissects through the subcutaneous tissue to expose the fracture.
3. The provider then realigns the fractured fragments or reduces any dislocated bones to restore normal alignment.
4. If necessary, the provider may use implants such as plates, screws, nails, or wires to stabilize the fracture.
5. The incision is closed by suturing the layers of skin together.
6. The patient’s finger or thumb is placed in a brace or splint to immobilize the area and promote healing.
7. An X-ray may be performed to confirm the reduction of the fracture.

4. Qualifying circumstances

CPT 26765 is used for patients who have a distal phalangeal fracture in a finger or thumb that requires open treatment with internal fixation. This procedure is typically performed by a healthcare provider who is experienced in orthopedic surgery. The use of implants for stabilization is considered a qualifying circumstance for this code.

5. When to use CPT code 26765

CPT code 26765 should be used when a healthcare provider performs an open treatment of a distal phalangeal fracture in a finger or thumb, and internal fixation is performed as part of the procedure. This code should be reported for each individual fracture treated.

6. Documentation requirements

To support a claim for CPT 26765, the healthcare provider must document the following information:

• Diagnosis of the distal phalangeal fracture
• Description of the procedure performed, including any specific techniques used
• Details of the internal fixation performed, if applicable
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 26765, ensure that the procedure meets the criteria for open treatment of a distal phalangeal fracture in a finger or thumb, including internal fixation if performed. It is important to accurately document the procedure and any qualifying circumstances to support the use of this code. CPT code 26765 should not be reported if the provider performs closed treatment of a distal phalangeal fracture without manipulation or percutaneous skeletal fixation.

8. Historical information

CPT code 26765 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, the code description was updated to include the option of internal or external fixation.

9. Examples

1. A surgeon performs an open treatment of a distal phalangeal fracture in a patient’s thumb, using internal fixation with screws to stabilize the fracture.
2. An orthopedic specialist performs an open treatment of a distal phalangeal fracture in a patient’s finger, using a plate and screws for internal fixation.
3. A hand surgeon performs an open treatment of a distal phalangeal fracture in a patient’s thumb, using a combination of pins and wires for internal fixation.
4. An orthopedic surgeon performs an open treatment of a distal phalangeal fracture in a patient’s finger, using a single screw for internal fixation.
5. A hand specialist performs an open treatment of a distal phalangeal fracture in a patient’s thumb, using a combination of plates and screws for internal fixation.
6. An orthopedic surgeon performs an open treatment of a distal phalangeal fracture in a patient’s finger, using a single pin for internal fixation.
7. A hand surgeon performs an open treatment of a distal phalangeal fracture in a patient’s thumb, using a combination of screws and wires for internal fixation.
8. An orthopedic specialist performs an open treatment of a distal phalangeal fracture in a patient’s finger, using a plate for internal fixation.
9. A hand surgeon performs an open treatment of a distal phalangeal fracture in a patient’s thumb, using a combination of pins and screws for internal fixation.
10. An orthopedic surgeon performs an open treatment of a distal phalangeal fracture in a patient’s finger, using a single screw for internal fixation.