Tendon Repair

Question:

I am new to orthopaedic hand coding. I have a case where the surgeon repaired two flexor tendons in the finger. I am being told that I may only report one CPT code because they were both repaired via the same incision. Is this correct? The surgeon, who is new, disagrees and says both repairs are reportable.

Answer:

The surgeon is correct and kudos to you for reaching out to verify what you were told.
It will be important to know if the repairs were “in zone 2” or “not in zone 2”..

To illustrate why the information you were given was incorrect, let’s look at the description of CPT code 26356 as an example.

Note in the description there are several important pieces of information:

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man’s land); primary, without free graft, each tendon
1. This code is used for the repair or advancement of a flexor tendon
2. The tendon is in zone 2
3. The last part of the code descriptor states “each tendon”

Some payors may allow you to report two, or multiple tendon repairs of the same type using units, while others may require the use of distinct services modifier 59 to indicate that the second (or subsequent) code represents repair of a different tendon. CMS does not allow modifier 59 on a duplicate CPT code.

Option 1: 26356 x 2
Option 2: 26356, 26356-59

When tendons are repaired in the fingers, you could also use finger modifiers FA-F9 to designate the specific finger location.

Good luck and please let us know if the KZA Orthopaedic Consulting team may be of assistance with future coding questions. You may contact Milka Djukic at
mdjukic@karenzupko.comfor information related to hourly consulting services to assist with operative note reviews, coding or practice management questions.