Percutaneous skeletal fixation of a single interphalangeal joint dislocation of the finger, performed with manipulation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $434.88
Total RVUs: 13.02
Global, days: 90
Region: Hand

Drawn from CMSBedrockbillingEatonhandEbhmcAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which finger and which interphalangeal joint (PIP vs. DIP) was treated
Confirm the dislocation diagnosis with pre-reduction imaging (X-ray date and findings)
Document that manipulation was performed as part of the procedure
Describe the percutaneous fixation technique, including wire size and number of pins placed
Record post-reduction imaging confirming joint alignment
Note laterality (left or right hand) explicitly in the operative note

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

LT Left side RT Right side 59 Distinct service 51 Multiple procedures 22 Increased complexity 78 Unplanned return — related 79 Unrelated during global 76 Repeat, same physician 77 Repeat, another physician

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26776 covers percutaneous pin fixation of an interphalangeal (IP) joint dislocation — either proximal (PIP) or distal (DIP) — when manipulation is required to reduce the joint and Kirschner wires are placed through the skin to maintain alignment. This is not a simple closed reduction; the percutaneous hardware is what separates 26776 from a manipulation-only approach. The code applies to a single joint in a single finger. Billing multiple fingers on the same hand requires separate line items with finger-specific laterality modifiers (LT/RT) and modifier 59 to establish distinct anatomical sites.

The 90-day global period means all routine post-operative care, pin site management, and uncomplicated hardware removal fall inside the global. Pin removal during the global is bundled unless you can document a separately identifiable service requiring a new decision or unplanned return to the OR. If an associated fracture is present at the same joint, review NCCI edits carefully — the dislocation and fracture codes for the same site may be bundled.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.87
Practice expense RVU	7.22
Malpractice RVU	0.93
Total RVU	13.02
Medicare national rate	$434.88
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	$434.88
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 26776 get rejected.

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

Missing laterality — claim submitted without LT or RT modifier causes payer rejection
Bundling with an open treatment code when the same joint site was addressed via a second approach in the same session
Routine pin removal billed separately during the 90-day global without documentation of a distinct separately identifiable service
ICD-10 diagnosis code reflects a fracture rather than a dislocation, mismatching the procedure code
Multiple fingers billed on the same line without modifier 59 to distinguish separate anatomical sites

Frequently asked questions

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

01Does 26776 cover both PIP and DIP joint dislocations?

Yes. The code applies to any single interphalangeal joint — proximal or distal. Specify which joint in the operative note; auditors flag notes that just say 'IP joint' without clarifying PIP vs. DIP.

02Can I bill 26776 twice if two fingers on the same hand are pinned?

Yes, bill 26776 on separate lines with modifier 59 (or XS for anatomically distinct site) to distinguish the procedures. Include LT or RT on both lines and identify the specific finger for each.

03Is pin removal bundled into the 26776 global period?

Routine pin removal within the 90-day global is bundled — bill nothing separately. If the patient requires a return to the OR for an unrelated problem during the global, use modifier 79. An unplanned return to address a complication of the original pin fixation uses modifier 78.

04What is the correct code if the dislocation requires open treatment instead of percutaneous pinning?

Open treatment of an interphalangeal joint dislocation is reported with a different code — 26785. Use 26776 only when fixation is achieved percutaneously without formal open exposure of the joint.

05If there's both a dislocation and a fracture at the same finger joint, how do I code that?

Check NCCI edits before billing both codes for the same joint in the same session. The fracture and dislocation codes at the same anatomical site may be bundled. Document clearly which pathology drove the fixation decision; if distinct procedures were performed at distinct sites, modifier 59 applies with supporting documentation.

06Does the same-day E&M need modifier 25 if 26776 is performed?

Yes. If a separately identifiable evaluation and management service occurred on the same day as 26776 — beyond the pre-procedural assessment — append modifier 25 to the E&M code and document the distinct medical decision-making in the note.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the specific finger, joint level (PIP or DIP), laterality, manipulation performed, wire gauge, number of pins placed, and post-reduction imaging confirmation directly from dictation. That detail prevents the two most common 26776 denials: a missing or ambiguous laterality modifier and an ICD-10 diagnosis that says fracture when the procedure code says dislocation.

See how Mira captures CPT 26776 documentation