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The procedure described by CPT® Code 26497 involves the transfer of a tendon to restore intrinsic function specifically in the ring and small fingers. This condition, often referred to as claw hand or claw finger, arises from a loss of intrinsic muscle function, leading to an imbalance between the intrinsic and extrinsic muscles of the hand. The intrinsic muscles, which include the interosseous and lumbrical muscles, are crucial for the fine motor control and dexterity of the fingers. In this procedure, the flexor digitorum superficialis (FDS) tendon of the ring finger is utilized to enhance the intrinsic function of both the ring and little fingers. By transferring the FDS tendon, the procedure aims to alleviate the clawing appearance and improve the flexion at the metacarpophalangeal (MCP) joint, thereby restoring more normal hand function. The FDS tendon is carefully detached from its original insertion point on the ring finger and is then split longitudinally. One half of the tendon is routed dorsally through the first interosseous muscle, while the other half is directed volarly and tunneled to the lumbrical muscle. This surgical intervention is critical for patients suffering from significant functional impairment due to claw hand, providing them with improved hand mechanics and overall quality of life.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 26497 is indicated for patients experiencing loss of intrinsic function in the ring and small fingers, which can lead to the development of claw hand or claw finger. This condition is characterized by an imbalance between the intrinsic and extrinsic muscles of the hand, resulting in difficulty with finger movement and grip. The transfer of the FDS tendon is performed to restore the necessary muscle function and improve the overall dexterity of the affected fingers.
The procedure for CPT® Code 26497 involves several critical steps to effectively transfer the tendon and restore function. First, the surgeon detaches the flexor digitorum superficialis (FDS) tendon from its insertion point on the ring finger. This detachment is essential to allow for the subsequent manipulation of the tendon. Next, the FDS tendon is split longitudinally into two halves. This splitting is crucial as it enables the surgeon to redirect the tendon to serve its new function. One half of the FDS tendon is then passed dorsally through the first interosseous muscle. This step is important as it positions the tendon in a way that it can effectively substitute for the interosseous muscle's function. The other half of the tendon is passed volarly and tunneled to the lumbrical muscle. This tunneling is a delicate process that ensures the tendon is correctly aligned to restore the necessary muscle function. By completing these steps, the procedure aims to relieve the clawing of the fingers and improve flexion at the metacarpophalangeal (MCP) joint, ultimately enhancing the patient's hand function.
After the completion of the tendon transfer procedure, patients typically require a period of rehabilitation to regain strength and function in the affected fingers. Post-operative care may include immobilization of the hand to allow for proper healing of the tendon transfer. Patients are often advised to engage in physical therapy to facilitate recovery and improve range of motion. The expected recovery time can vary depending on individual circumstances, but close monitoring of the surgical site and adherence to rehabilitation protocols are essential for optimal outcomes. Additionally, patients may need to follow up with their healthcare provider to assess the success of the procedure and make any necessary adjustments to their rehabilitation plan.
| Short Descr | FINGER TENDON TRANSFER | Medium Descr | TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR | Long Descr | Transfer of tendon to restore intrinsic function; ring and small 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) | 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) | 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). | 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.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | 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 | GW | Service not related to the hospice patient's terminal condition | 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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