Coding Ahead
CasePilot
Medical Coding Assistant
CaseConsultant
Instant Email Coding Consultant
Case2Code
Search and Code Lookup Tool
CareerCenter
Medical Coding Job Board
Log in Register free account

Need help choosing the right code?

Ask CasePilot about procedures, modifiers, bundling, and coding guidance.

Try CasePilot

Official Description

Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 26390 involves the excision of a flexor tendon in the hand or finger, accompanied by the implantation of a synthetic rod. This procedure is typically indicated when a flexor tendon repair has either failed or has not been performed in a timely manner, necessitating a delayed flexor tendon grafting approach. The process is executed in two stages, with the first stage being the focus of this code. During this initial stage, a zigzag incision is made over the affected tendon to access the injured area. Careful dissection of the surrounding soft tissues is performed to protect vital neurovascular structures. The tendon sheath is then incised, allowing for the injured tendon to be meticulously dissected free from the surrounding tissue and subsequently excised. Following the removal of the damaged tendon, a synthetic rod is inserted along the entire length of the tendon sheath. This rod serves as a scaffold for the healing process, remaining in place for approximately 10 weeks while the tendon sheath heals around it. After this healing period, the second stage of the procedure, which involves the actual tendon grafting, can be performed under a different CPT® code. The careful execution of this procedure is crucial for restoring function and mobility to the affected hand or finger.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 26390 is indicated for specific conditions related to the flexor tendon in the hand or finger. These indications include:

  • Failed Flexor Tendon Repair The procedure is performed when a previous attempt to repair the flexor tendon has not been successful, necessitating a new approach to restore function.
  • Delayed Flexor Tendon Grafting This procedure is indicated when the flexor tendon repair has not been conducted in a timely manner, requiring a two-stage surgical intervention to ensure proper healing and functionality.

2. Procedure

The procedure for CPT® Code 26390 involves several critical steps that are executed with precision to ensure successful outcomes. The steps are as follows:

  • Step 1: Incision A zigzag incision is made over the affected tendon to provide access to the surgical site. This type of incision is designed to minimize scarring while allowing adequate exposure of the tendon.
  • Step 2: Dissection The surrounding soft tissues are carefully dissected to expose the tendon while protecting the neurovascular structures that are critical for hand function. This step requires meticulous attention to detail to avoid damaging these vital components.
  • Step 3: Incision of the Tendon Sheath The tendon sheath is incised to facilitate access to the injured tendon. This allows for the proper evaluation and treatment of the tendon injury.
  • Step 4: Tendon Excision The injured tendon is dissected free from the surrounding tissue and excised. This step is crucial as it removes the damaged portion of the tendon that cannot heal properly.
  • Step 5: Insertion of Synthetic Rod A synthetic rod is then inserted along the entire length of the tendon sheath. This rod acts as a support structure, allowing the tendon sheath to heal around it, which is essential for the success of the subsequent tendon grafting.
  • Step 6: Closure Finally, the overlying soft tissues and skin are closed in layers to ensure proper healing and minimize the risk of complications. This layered closure technique helps to restore the integrity of the skin and underlying tissues.

3. Post-Procedure

After the completion of the procedure coded by CPT® 26390, the patient is expected to undergo a recovery period during which the synthetic rod remains in place for approximately 10 weeks. During this time, the tendon sheath heals around the rod, which is critical for the success of the subsequent tendon grafting procedure. Post-procedure care may include monitoring for signs of infection, managing pain, and ensuring that the surgical site is kept clean and dry. Patients may also be advised on activity restrictions to prevent undue stress on the healing tendon sheath. Follow-up appointments will be necessary to assess the healing process and to plan for the second stage of the procedure, which involves the actual tendon grafting.

Short Descr REVISE HAND/FINGER TENDON
Medium Descr EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
Long Descr Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod
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) 1 - Co-surgeons could be paid, though supporting documentation is required...
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 Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5B - Ambulatory procedures - musculoskeletal
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
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
GC This service has been performed in part by a resident under the direction of a teaching physician
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
Date
Action
Notes
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"