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Official Description

Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 26432 refers to the closed treatment of a distal extensor tendon insertion, which may occur with or without the use of percutaneous pinning, commonly associated with conditions such as mallet finger. Mallet finger is characterized by a flexion deformity of the distal interphalangeal joint, resulting in the inability to straighten the affected finger. This injury typically arises from a blunt force applied to the fingertip, leading to a tear or rupture of the distal extensor tendon. In certain instances, the injury may also involve an avulsion fracture, where a fragment of bone is pulled away along with the tendon. The closed treatment approach aims to facilitate healing of the damaged tendon while maintaining proper alignment and function of the finger. This is often achieved through the application of a splint that keeps the finger fully extended during the healing process. In cases where additional stabilization is necessary, a Kirschner wire may be utilized, which is inserted through the distal phalanx and across the distal interphalangeal joint into the middle phalanx, ensuring that the finger remains in an extended position to promote optimal recovery.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The closed treatment of distal extensor tendon insertion, as described by CPT® Code 26432, is indicated for specific conditions and injuries that affect the distal extensor tendon. These include:

  • Mallet Finger A condition characterized by the inability to extend the distal interphalangeal joint due to a rupture or tear of the distal extensor tendon, often resulting from trauma.
  • Distal Extensor Tendon Injuries Injuries to the tendon that may occur due to blunt force trauma, leading to pain, swelling, and functional impairment of the finger.
  • Avulsion Fractures Instances where a piece of bone is pulled away from the distal phalanx along with the tendon, necessitating treatment to restore function and alignment.

2. Procedure

The procedure for closed treatment of distal extensor tendon insertion involves several key steps to ensure proper healing and alignment of the affected finger. These steps include:

  • Assessment of Injury The healthcare provider begins by thoroughly assessing the injury, including a physical examination of the finger to determine the extent of the tendon damage and any associated fractures.
  • Application of Splint Once the assessment is complete, a splint is applied to the affected finger. The splint is designed to keep the finger in a fully extended position, which is crucial for allowing the distal extensor tendon to heal properly.
  • Consideration of Percutaneous Pinning In cases where additional stabilization is required, the provider may opt to perform percutaneous pinning. This involves the insertion of a Kirschner wire through the distal phalanx, across the distal interphalangeal joint, and into the middle phalanx to maintain the finger's extension during the healing process.
  • Post-Procedure Instructions After the treatment is completed, the patient receives specific instructions regarding care for the splint or pin, including how to manage pain and when to follow up for further evaluation.

3. Post-Procedure

Following the closed treatment of the distal extensor tendon insertion, patients are typically advised to keep the splint in place for a specified duration to ensure proper healing. It is essential to monitor the finger for any signs of complications, such as increased pain, swelling, or changes in color. Patients may also be instructed to avoid using the affected finger during the recovery period to prevent re-injury. Follow-up appointments are crucial to assess the healing process and determine when it is safe to begin rehabilitation exercises aimed at restoring range of motion and strength to the finger.

Short Descr REPAIR FINGER TENDON
Medium Descr CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
Long Descr Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet 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 2
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).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
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
GC This service has been performed in part by a resident under the direction of a teaching physician
GJ "opt out" physician or practitioner emergency or urgent service
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
U6 Medicaid level of care 6, as defined by each state
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
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Pre-1990 Added Code added.
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