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Official Description

Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each finger

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 26426 involves the repair of the extensor tendon, specifically the central slip, which is a critical component in the function of the fingers. The extensor tendons are responsible for the extension of the fingers, allowing them to straighten. The central slip is a specific part of the extensor tendon that attaches to the middle phalanx of the finger. When this slip is damaged, it can lead to a condition known as boutonniere deformity, characterized by the inability to fully extend the finger at the proximal interphalangeal joint. This injury can occur due to various reasons, including a direct impact to a bent finger, a laceration that severs the tendon, or conditions such as rheumatoid arthritis. The repair procedure classified under this code is considered a secondary repair, which means it is performed after a primary repair has failed or after a significant delay following the initial injury. The surgical approach involves making an incision over the top of the finger to access the extensor tendon and central slip. The repair techniques may vary based on the specific nature of the injury, but they typically involve the rearrangement of local tissues, including the lateral bands of the tendon. This may include repositioning the lateral bands to stabilize the joint or using one lateral band to reconstruct the central slip while elongating the opposite band. Additionally, a Kirschner wire is often utilized to maintain the proximal interphalangeal joint in an extended position during the healing process. This procedure is essential for restoring the function of the finger and preventing long-term complications associated with tendon injuries.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 26426 is indicated for the following conditions:

  • Boutonniere Deformity - This condition arises when the central slip of the extensor tendon is injured, leading to an inability to fully extend the finger at the proximal interphalangeal joint.
  • Injury to the Central Slip - This includes injuries caused by forceful trauma, such as a blow to a bent finger or lacerations that sever the tendon from its attachment.
  • Rheumatoid Arthritis - This chronic inflammatory condition can lead to tendon damage and deformities, necessitating surgical intervention for repair.
  • Failed Primary Repair - The procedure is also indicated for patients who have previously undergone a primary repair of the central slip that was unsuccessful.

2. Procedure

The procedure for repairing the extensor tendon and central slip involves several critical steps:

  • Incision - A surgical incision is made over the top of the affected finger to provide access to the extensor tendon and the central slip. This incision allows the surgeon to visualize and assess the extent of the injury.
  • Exposure of the Tendon - Once the incision is made, the surgeon carefully exposes the extensor tendon and the central slip. This step is crucial for determining the appropriate repair technique based on the specific nature of the injury.
  • Local Tissue Rearrangement - The repair technique may involve rearranging local tissues, including the lateral bands of the tendon. The lateral bands may be repositioned dorsally or utilized to reconstruct the central slip, depending on the injury's characteristics.
  • Stabilization of the Joint - To stabilize the proximal interphalangeal joint during the healing process, a Kirschner wire is inserted through the distal phalanx and into the middle phalanx. This wire holds the joint in an extended position, facilitating proper healing of the repaired tendon.

3. Post-Procedure

After the procedure, patients typically require careful monitoring and follow-up care to ensure proper healing. The finger may be immobilized to protect the repair and maintain the joint in an extended position. Rehabilitation may involve physical therapy to restore range of motion and strength in the finger. Patients should be advised on activity restrictions and signs of complications, such as increased pain or swelling, that may require further evaluation. The overall recovery time can vary based on the extent of the injury and the individual’s healing response.

Short Descr REPAIR FINGER/HAND TENDON
Medium Descr RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
Long Descr Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each finger
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) 1 - Statutory payment restriction for assistants at surgery applies 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) P5B - Ambulatory procedures - musculoskeletal
MUE 4
CCS Clinical Classification 160 - Other therapeutic procedures on muscles and tendons
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
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).
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.
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.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
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
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
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Notes
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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