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Official Description

Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Capsulectomy or capsulotomy is a surgical procedure aimed at addressing contractures in the metacarpophalangeal (MCP) or interphalangeal (IP) joints, which can occur due to various conditions such as disease, burns, or other injuries. The primary goal of this procedure is to relieve either extension or flexion contractures that restrict the normal range of motion in these joints. In the context of CPT® Code 26520, the focus is specifically on the treatment of contractures affecting the MCP joint. The procedure involves making incisions in strategic locations depending on the type of contracture present. For extension contractures, an incision is made on the dorsal side of the joint, while for flexion contractures, the incision is made on the volar side. The surgical steps include incising the retinaculum, freeing it from the collateral ligament, and incising or excising portions of the joint capsule to alleviate the contracture. This meticulous approach not only aims to restore function but also to enhance the overall range of motion in the affected joint.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure of capsulectomy or capsulotomy is indicated for the following conditions:

  • Extension Contracture of the MCP Joint This condition occurs when the fingers cannot fully extend due to tightness or shortening of the surrounding soft tissues.
  • Flexion Contracture of the MCP Joint This condition arises when the fingers are unable to fully flex, often resulting from scarring or other injuries affecting the joint.
  • Injury or Trauma Any injury that leads to scarring or contracture formation around the MCP joint may necessitate this surgical intervention.
  • Burns Burns that affect the hand and lead to contractures can also be a reason for performing this procedure to restore function.

2. Procedure

The capsulectomy or capsulotomy procedure involves several detailed steps, which vary depending on whether the contracture is an extension or flexion type.

  • Step 1: Incision for Extension Contracture An incision is made over the dorsal aspect of the affected MCP joint. This incision allows access to the underlying structures that need to be addressed to relieve the contracture.
  • Step 2: Incising the Retinaculum The retinaculum is incised perpendicular to the common extensor, following the direction of the fibers at the joint margin. This step is crucial for freeing the retinaculum from the underlying collateral ligament.
  • Step 3: Incising the Joint Capsule The joint capsule is then incised, and a portion may be excised to further relieve the contracture and improve the range of motion.
  • Step 4: Re-establishing the Volar Recess After addressing the contracture, the volar recess is re-established to ensure proper joint function.
  • Step 5: Positioning the Joint The joint is positioned in flexion, and a pin is used to maintain this position during the healing process.
  • Step 6: Incision for Flexion Contracture For a flexion contracture, an incision is made over the volar aspect of the MCP joint. This allows for direct access to the fibrous tissue that may be causing the contracture.
  • Step 7: Excising Fibrous Tissue Subcutaneous fibrous tissue and/or fascial bands are excised as necessary, while care is taken to identify and protect the neurovascular bundles.
  • Step 8: Excising the Collateral Ligament The lower portion of the collateral ligament, along with the overlying retinaculum, is excised to facilitate the release of the contracture.
  • Step 9: Finalizing the Procedure The joint capsule is incised, and a portion may be excised as needed. Each MCP joint treated with capsulectomy or capsulotomy should be reported separately.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for signs of infection and ensuring that the joint is maintained in the correct position as per the surgical plan. Patients may require physical therapy to regain strength and range of motion in the affected joint. The expected recovery time can vary based on the extent of the procedure and the individual’s healing response. It is essential to follow up with the healthcare provider to assess the healing process and make any necessary adjustments to rehabilitation protocols.

Short Descr RELEASE KNUCKLE CONTRACTURE
Medium Descr CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
Long Descr Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint
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 150 - Division of joint capsule, ligament or cartilage
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.)
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
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
ET Emergency services
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
T1 Left foot, second digit
T5 Right foot, great toe
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
Date
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Pre-1990 Added Code added.
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