2025 CPT code 26358

Secondary repair of a flexor tendon in the "no man's land" area of a finger, with the use of a free graft.

Follow the American Medical Association (AMA) CPT coding guidelines and payer-specific instructions for appropriate coding and billing.Consider the use of appropriate finger modifiers (F1-F9, FA) to specify the affected finger.

Modifiers such as 51 (multiple procedures), 59 (distinct procedural service), and 76 (repeat procedure) may be applicable depending on the circumstances of the case and payer requirements.Finger modifiers (F1-F9, FA) are also used to identify the specific finger involved.

Medical necessity is established by demonstrating significant functional impairment resulting from the flexor tendon injury that cannot be resolved with non-surgical management.The need for a free graft highlights the severity of the injury, further supporting the medical necessity of surgical repair.

The surgeon's responsibilities include performing a thorough examination, making a diagnosis, obtaining informed consent, planning the surgical approach, meticulously performing the tendon repair and graft placement, managing bleeding and closing the wound. Postoperative care and follow-up are included in the global surgical period.

IMPORTANT 26356 (primary repair without graft), 26357 (secondary repair without graft), 26352 (secondary repair with graft outside "no man's land")

In simple words: The doctor fixes a severely torn tendon in one of your fingers. This tear is in a difficult-to-reach area of the hand.To complete the repair, the doctor uses a piece of tendon from another part of your hand.

This CPT code, 26358, represents the surgical repair or advancement of a single flexor tendon within Zone 2 of the digital flexor tendon sheath (commonly known as "no man's land"), which is the area between the palm and the lower third of the finger.The procedure is classified as secondary, meaning it's performed more than seven days post-injury.It involves the use of a free graft, meaning a tendon graft harvested from another location, to complete the repair. The code includes obtaining the graft and the repair itself.Each tendon repaired requires a separate code.

Example 1: A patient presents with a deep laceration to their right ring finger, involving the flexor tendon in Zone 2. The injury occurred 10 days prior, and the tendon is severely damaged requiring a secondary repair with a free tendon graft., A patient sustains a crush injury to their left index finger, resulting in a complete transection of the flexor digitorum profundus tendon in Zone 2.The injury is more than 7 days old, and the tendon requires a secondary repair using a free tendon graft from the palmaris longus tendon., A patient suffers a severe laceration to the flexor tendons in their right thumb, encompassing both superficialis and profundus tendons in Zone 2. After initial debridement and exploration, the surgeon determines that a secondary repair with free tendon grafts is necessary for both tendons, requiring two units of 26358.

** Accurate coding requires careful documentation of the surgical procedure.Ensure that the operative report clearly specifies the location of the tendon injury, the type of repair performed, and the source of the graft.

  • Revenue Code: P5B (Ambulatory Procedures - Musculoskeletal)
  • RVU: The relative value units (RVUs) for this code will vary depending on the payer, geographic location and other factors such as facility vs non-facility settings.Check the specific payer's fee schedule for current RVU information.
  • Global Days : The global period for this procedure is determined by payer specific policies. It may be 0, 10 or 90 days, or other value, depending on the complexity and extent of surgical procedure and payer-specific policy.
  • Payment Status: Active
  • Modifier TC rule: A technical component (TC) modifier is not applicable to this code because it represents a complete surgical procedure.
  • Fee Schedule : Historical fee schedule data is not available in the provided sources.Refer to your payer's fee schedules and historical data for specific reimbursement information.
  • Specialties:Hand Surgery, Orthopedic Surgery, Plastic Surgery
  • Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)
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