2025 CPT code 26863
(Active) Effective Date: N/A Revision Date: N/A Surgery - Arthrodesis Procedures on the Hand and Fingers Musculoskeletal System Feed
Arthrodesis of each additional interphalangeal joint of a finger, with or without internal fixation; with autograft (includes obtaining graft).
Modifiers 51 (multiple procedures), 76 (repeat procedure), and 52 (reduced services) might be applicable in specific circumstances but should be carefully considered based on the specific details of the procedure and medical necessity.
Medical necessity is established by the presence of severe, symptomatic arthritis or significant joint instability (e.g., post-traumatic) that significantly impairs hand function and that is not adequately managed by conservative measures.Documentation must support this.
The clinical responsibility lies with the surgeon performing the arthrodesis. This includes proper patient assessment, surgical planning, executing the procedure, including harvesting an autograft, achieving hemostasis, and appropriately closing the surgical site.Post-operative care and follow-up are also within their responsibility.
In simple words: This code describes an extra step in finger surgery where the doctor fuses another joint in the same finger during the same operation.They might use small metal pieces to hold the joint together and will use a piece of bone from another part of the body to help the joint heal and fuse. This is only billed if a previous finger joint fusion is also performed in the same surgical session.
This CPT code, 26863, represents an add-on procedure for the surgical fusion (arthrodesis) of an additional interphalangeal joint in a finger.This is performed following an initial interphalangeal joint arthrodesis during the same surgical session. The procedure may involve the use of internal fixation devices (such as pins, wires, or screws) for stabilization.It also includes obtaining and using an autogenous bone graft (typically from the iliac crest) to promote bone fusion at the joint.The code is reported separately in addition to the primary procedure code (26862).Each additional fused joint requires a separate unit of this code.The removal of articular cartilage and other surgical steps to prepare the joint for fusion are inherent to the procedure.
Example 1: A patient presents with severe osteoarthritis in the second and third interphalangeal joints of their right index finger. The surgeon performs an arthrodesis of the second interphalangeal joint (26862) and then fuses the third interphalangeal joint using the same surgical approach (26863). An autograft is used in both joints., A patient with rheumatoid arthritis affecting multiple finger joints undergoes an arthrodesis of the distal interphalangeal joint of the left middle finger (26862). During the same procedure, the surgeon decides to also fuse the proximal interphalangeal joint of the same finger due to advanced disease in that joint (26863).The surgery includes internal fixation and autograft in both joints., A patient sustains a severe comminuted fracture involving the proximal and distal interphalangeal joints of the left ring finger. After open reduction and internal fixation of the fracture, the surgeon decides to perform arthrodesis of both joints due to the severity of the injury (26862, 26863).Autologous bone graft is used.
Detailed operative report including the specific joints involved, the use of internal fixation, and the details of the autograft harvesting and placement (site of harvest and amount).Preoperative radiographic images demonstrating the arthritis or fracture.Post-operative images verifying the reduction and fixation.Progress notes demonstrating the patient’s progress post-op.
** Careful documentation is crucial for accurate coding and reimbursement.Always refer to the most current CPT manual and payer guidelines for specific coding and billing rules.This code is for the additional joint fusion only and does not include the initial fusion.
- Revenue Code: P5B (AMBULATORY PROCEDURES - MUSCULOSKELETAL)
- RVU: The RVUs for this code will vary depending on the geographic location and other factors.Consult the appropriate fee schedule for accurate RVU values.
- Global Days: The global period for this add-on code is inherent to the global surgical period of the primary procedure (26862).Therefore, a specific global day explanation is not applicable to this code alone.
- Payment Status: Active
- Modifier TC rule: No technical component (TC) modifier is applicable as this is a surgical procedure and includes the professional component.
- Fee Schedule: The historical fee schedule data is not available.Consult the appropriate payer’s fee schedule for historical and current reimbursement information.
- Specialties:Orthopedic Surgery, Hand Surgery
- Place of Service:Ambulatory Surgical Center, Hospital (Inpatient or Outpatient), Office