Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
The CPT® Code 26357 refers to the surgical procedure for the repair or advancement of a flexor tendon located in zone 2 of the digital flexor tendon sheath, commonly known as "no man's land." This area is critical for hand function and is defined as the region between the insertion of the flexor digitorum superficialis tendon and the proximal A1 pulley, extending from the proximal end of the proximal phalanx to the distal end of the middle phalanx. Injuries to the flexor tendons in this zone can result from partial or complete lacerations, tears, or ruptures, which may severely impact a patient's ability to flex their fingers. The procedure coded as 26357 is specifically categorized as a secondary repair, which is performed more than two weeks after the initial injury. This contrasts with primary repairs, which are typically conducted within 24 hours of the injury unless complications such as gross contamination necessitate a delay of up to two weeks. During the surgical intervention, the tendon is accessed through a volar zigzag or lateral incision, with careful dissection of the surrounding soft tissues to protect vital neurovascular structures. The surgeon locates the distal and proximal ends of the severed tendon, which may require additional incisions if the proximal end has retracted. The repair involves approximating and suturing the tendon ends together, ensuring proper alignment and tension to restore function. This procedure is crucial for patients who have sustained significant tendon injuries, as it aims to restore the integrity and functionality of the flexor tendon, thereby improving hand movement and overall quality of life.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure coded as CPT® 26357 is indicated for patients who have sustained injuries to the flexor tendons in zone 2 of the digital flexor tendon sheath. The specific indications for this procedure include:
The procedure for CPT® 26357 involves several critical steps to ensure effective repair of the flexor tendon. The steps are as follows:
Following the procedure coded as CPT® 26357, patients typically require careful monitoring and post-operative care to ensure proper healing. This may include immobilization of the affected digit to prevent strain on the repaired tendon. Patients are often advised on rehabilitation exercises to gradually restore movement and strength to the finger. The recovery process may vary depending on the extent of the injury and the individual’s healing response, but close follow-up with the healthcare provider is essential to assess the success of the repair and to manage any complications that may arise.
| Short Descr | REPAIR FINGER/HAND TENDON | Medium Descr | RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON | Long Descr | Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendon | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 2 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | F9 | Right hand, fifth digit | FA | Left hand, thumb | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2004-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.