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Official Description

Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 26433 involves the repair of the extensor tendon at its distal insertion, specifically addressing injuries that can lead to 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 occurs due to a blunt force trauma to the fingertip, which can cause the tendon to tear or rupture. In some instances, the injury may also involve an avulsion fracture, where a fragment of bone is pulled away along with the tendon. The repair can be classified as either primary or secondary; primary repair is generally performed within 24 hours of the injury, while secondary repair is indicated for cases where the repair is conducted more than two weeks post-injury. The surgical approach involves exposing the tendon through a dorsal incision, with careful dissection of the surrounding soft tissues to protect vital neurovascular structures. The surgeon locates the distal and proximal ends of the ruptured tendon, which may necessitate an additional incision for proper access. The repair process involves approximating and suturing the tendon ends together, and if there is an associated bone fragment, it may be secured to the distal phalanx using a pin or screw. This procedure is crucial for restoring function to the finger and is reported for each flexor tendon that is repaired.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 26433 is indicated for the following conditions:

  • Mallet Finger - A condition resulting from an injury to the distal extensor tendon insertion, leading to a flexion deformity of the distal interphalangeal joint.
  • Tendon Rupture - Occurs due to blunt force trauma to the fingertip, causing the extensor tendon to tear or rupture.
  • Avulsion Fracture - In some cases, the injury may involve a piece of bone being pulled away along with the tendon.

2. Procedure

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

  • Step 1: Incision and Exposure - A dorsal incision is made to expose the extensor tendon. This incision allows the surgeon to access the site of the injury while taking care to protect the surrounding neurovascular structures during dissection.
  • Step 2: Identification of Tendon Ends - The surgeon locates the distal and proximal ends of the ruptured tendon. In some cases, this may require a separate incision to adequately visualize and access the tendon ends.
  • Step 3: Approximation and Suturing - Once the tendon ends are identified, they are approximated and sutured together. This step is crucial for restoring the continuity of the tendon and ensuring proper function of the finger.
  • Step 4: Bone Fragment Stabilization (if applicable) - If a piece of bone has been avulsed along with the tendon, it may be secured to the distal phalanx using a pin or screw to stabilize the fracture and facilitate healing.

3. Post-Procedure

After the procedure, the patient will typically require a period of immobilization to allow for proper healing of the tendon repair. The recovery process may involve follow-up visits to monitor the healing progress and assess the function of the finger. Rehabilitation exercises may be recommended to restore range of motion and strength once the initial healing phase has concluded. It is essential to follow the surgeon's post-operative care instructions to optimize recovery and minimize the risk of complications.

Short Descr REPAIR FINGER TENDON
Medium Descr REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
Long Descr Repair of extensor tendon, distal insertion, primary or secondary; without graft (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
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.
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
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
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
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