As per report, there are open fractures at P2 of ring and middle finger. CPT code 26765 is for the ORIF distal phalangeal fracture, finger or thumb, which is P3 of finger. Each finger is composed of proximal (P1), middle (P2), and distal (P3) phalanx, except for the thumb. In your case, it is P2 (middle phalanx), so CPT 26735 is appropriate to bill instead of 26765. In CPT 26735 (Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each), the provider makes an incision in the skin over the fractured bone (Ring and Middle Finger-P2 in your case). He then dissects down through subcutaneous tissue, protecting the nerves and vessels. He retracts the muscles to have adequate exposure of the phalanx fracture. He then adjusts the bone to reduce the fractured fragments, or to bring the dislocated bones back to their normal alignment. He may fix the fracture using implants like a plate, screws, nail, or wires. He closes the wound by suturing the skin layers together. He places the patient’s finger in a brace or splint for a period of about four weeks. Hence, splint will not be coded separately. Also, he may perform an X–ray examination of the finger or thumb bone to confirm the reduction of the fracture.
Per coding perspective, use CPT 26735 for the ORIF of left ring finger P2 with modifier F3 (Left hand, fourth digit) and again CPT 26735 for left middle finger P2 with modifier F2 (Left hand, third digit).
CPT 26418 is for middle finger extensor tendon repair. In this procedure, provider uses this procedure to treat an injury of an extensor tendon by primary or secondary repair. He dissects through subcutaneous tissue and gains adequate exposure of the extensor tendon. He then repairs the tendon to restore the lost function caused by injury of the tendon. Finally, he obtains hemostasis at the surgical site and closes the wound by suturing the soft tissue in layers. Use one unit of this code for each tendon repaired. This code does not include the use of a graft for repair. Also, append modifier F2 for left hand, third digit.
CPT 11760 can be used for the avulsion of nail repair. In CPT 11760, the physician removes the nail and repairs the nail bed. He can perform a hematoma evaluation or drain blood with absorbable sutures, which is included in this code. Check the documentation for nail repair, if anything is missing from the procedure then append the modifier 52 (Reduce Services). Also, append modifier F4 for left hand, fifth digit.
Since, your provider has performed the fluoroscopy, then use CPT 76000 for this service. According to the guidelines, code 76000 is a column 2 code for 26735, modifier 59 is allowed in order to differentiate between the services provided. Use modifier 59 with code 76000.
Hope this helps!