Open surgical treatment of a distal phalanx fracture of the finger or thumb, including internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $486.65
Total RVUs: 14.57
Global, days: 90
Region: Hand

Drawn from CMSAAPCJucmEatonhand

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Operative note must describe surgical exposure of the distal phalanx fracture site — not just percutaneous pin insertion
Specify which digit(s) were treated and laterality (left vs. right hand, specific finger)
Document all fixation hardware used: K-wires, screws, plates, or intramedullary devices
Record intraoperative fluoroscopy or X-ray confirmation of fracture reduction when performed
If converted from attempted closed reduction, document the failed attempt and rationale for open approach
ICD-10-CM code must specify the correct phalanx (distal), finger, laterality, and encounter type (initial vs. subsequent)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26765 covers open treatment of a distal phalangeal fracture — finger or thumb — with or without internal fixation. 'Open treatment' means the surgeon surgically exposes the fracture site for direct visualization, then stabilizes it using implants such as K-wires, screws, or plates before closing. This is distinct from closed or percutaneous treatment; the operative note must reflect actual surgical exposure, not just skin-level access for pin placement.

A critical billing distinction: an open (traumatic) fracture diagnosis does not automatically justify 26765. The procedure code is driven by the surgical method, not the wound classification. If the surgeon sets and splints a traumatically open distal phalanx fracture without operative exposure, that is closed treatment — report 26750 or 26756, not 26765. Auditors cross-reference the operative report against the ICD-10 encounter type; mismatches are a common denial trigger.

The code carries a 90-day global period. Routine post-op visits, hardware checks, and dressing changes within that window are bundled. If the fracture involves multiple digits, report 26765 for each digit treated with open reduction, using laterality modifiers (LT/RT) and modifier 59 to distinguish separate operative sites. When open debridement of contaminated bone is performed before definitive fixation, codes 11010–11012 may be separately reportable.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.71
Practice expense RVU	7.74
Malpractice RVU	1.12
Total RVU	14.57
Medicare national rate	$486.65
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$486.65
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26765 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Operative note documents only percutaneous pin placement without surgical exposure — correct code is 26756, not 26765
Open (traumatic) wound diagnosis coded as justification for 26765 when the surgical approach was actually closed treatment
Multiple digits billed without laterality or digit-specific modifiers, triggering duplicate-service edits
E/M service billed same-day without modifier 25, bundled into the minor surgical procedure payment
Missing or vague operative note that references 'standard approach' without naming the exposure technique

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 26765 just because the fracture diagnosis is coded as an open fracture?

No. The procedure code reflects the surgical method, not the wound classification. A traumatically open distal phalanx fracture that is splinted without operative exposure is still closed treatment. Use 26750 or 26756 for those scenarios.

02If I treat two digits on the same hand, do I bill 26765 twice?

Yes — 26765 is reported 'each' for every digit treated with open reduction. Use modifier 59 to indicate distinct procedural services and add LT or RT for laterality. Document each digit separately in the operative note.

03The surgeon attempted closed reduction first, then converted to open. How do I code that?

Bill 26765 for the definitive open procedure. The failed closed reduction attempt is not separately reportable — it is part of the same surgical session. Document the conversion narrative in the operative note to support medical necessity.

04Is debridement separately billable when performed before open fixation of a contaminated fracture?

Yes. When the surgeon performs excisional debridement of bone and soft tissue at an open fracture site before fixation, codes 11010–11012 may be reported separately with modifier 59 to distinguish from the fixation procedure.

05What global period applies to 26765, and what does it cover?

26765 carries a 90-day global period. That includes the day-before visit, the surgery, and all routine post-op care through day 90 — hardware checks, dressing changes, and suture removal. Unrelated E/M services during the global window need modifier 24; a new unrelated procedure needs modifier 79.

06Can an E/M be billed on the same day as 26765?

Only if it is a significant and separately identifiable service unrelated to the decision to perform the fracture fixation. Append modifier 25 to the E/M. The same diagnosis can appear on both — that alone does not disqualify the E/M.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the surgical exposure method, specific digit and laterality, fixation hardware type, intraoperative imaging confirmation, and any conversion narrative from failed closed reduction — directly from dictation. This prevents the most common audit flag: an operative note that supports 26756 (percutaneous) being billed as 26765 (open), and protects against laterality-related claim edits on multi-digit cases.

See how Mira captures CPT 26765 documentation