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Official Description

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 26235 involves a partial excision of bone, specifically targeting the proximal or middle phalanx of the finger to address osteomyelitis, which is an infection of the bone. This surgical intervention may also be referred to as craterization, saucerization, or diaphysectomy. Craterization and saucerization are techniques that focus on removing infected and necrotic bone to create a shallow depression on the bone surface, facilitating drainage from the infected area. On the other hand, diaphysectomy pertains to the removal of the infected segment of the shaft of a long bone. The procedure begins with an incision through the skin and soft tissue over the osteomyelitis site, allowing access to the infected area. The surgeon will then resect any soft tissue sinus tracts and devitalized soft tissue to expose the necrotic and infected bone. The extent of bone removal is determined by the severity of the infection, and the procedure aims to eliminate all infected tissue while preserving as much healthy bone as possible. This meticulous approach is crucial for promoting healing and preventing further complications associated with osteomyelitis.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 26235 is indicated for the treatment of osteomyelitis affecting the proximal or middle phalanx of the finger. Osteomyelitis is characterized by the infection of the bone, which can lead to significant complications if not addressed promptly. The following conditions may warrant this surgical intervention:

  • Osteomyelitis A bone infection that can result from various causes, including bacterial infections, which may necessitate surgical intervention to remove infected bone tissue.
  • Necrotic Bone The presence of dead or devitalized bone tissue that requires excision to prevent further infection and promote healing.
  • Soft Tissue Sinus Tracts The existence of abnormal channels or tracts in the soft tissue that may be associated with the infection, which need to be addressed during the procedure.

2. Procedure

The procedure for CPT® Code 26235 involves several critical steps to effectively treat osteomyelitis in the proximal or middle phalanx of the finger. Each step is designed to ensure thorough removal of infected tissue while preserving healthy bone.

  • Step 1: Incision The surgeon begins by making an incision in the skin over the site of osteomyelitis. This incision is carefully extended through the soft tissue to gain access to the underlying bone.
  • Step 2: Resection of Soft Tissue Once the incision is made, any soft tissue sinus tracts and devitalized soft tissue are resected. This step is crucial for exposing the area of necrotic and infected bone, allowing for a clear view of the surgical site.
  • Step 3: Exposure of Infected Bone After resecting the soft tissue, the surgeon exposes the necrotic and infected bone. This exposure is essential for the subsequent steps of the procedure.
  • Step 4: Drilling and Excavation A series of drill holes are created in the infected bone. The bone between these drill holes is then excavated using an osteotome to form an oval window. The extent of bone removal is determined by the severity of the infection.
  • Step 5: Curettage A curette may be utilized to remove any remaining devitalized tissue from the medullary canal, ensuring that all infected material is eliminated.
  • Step 6: Irrigation Once all devitalized and infected tissue has been removed, the surgical site is copiously irrigated with sterile saline or an antibiotic solution to cleanse the area and reduce the risk of postoperative infection.
  • Step 7: Closure Finally, the surgical wound is loosely closed, and a drain may be placed to facilitate any necessary drainage from the site.

3. Post-Procedure

After the completion of the procedure, appropriate post-operative care is essential for optimal recovery. The patient may be monitored for signs of infection or complications. Pain management strategies will be implemented, and the surgical site should be kept clean and dry. The presence of a drain may require specific care instructions to ensure proper drainage and prevent fluid accumulation. Follow-up appointments will be necessary to assess healing and determine if further interventions are needed. The overall recovery time will depend on the extent of the procedure and the patient's individual healing process.

Short Descr PARTIAL REMOVAL FINGER BONE
Medium Descr PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER
Long Descr Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5B - Ambulatory procedures - musculoskeletal
MUE 2
CCS Clinical Classification 142 - Partial excision bone

This is a primary code that can be used with these additional add-on codes.

20700 Add-on Code MPFS Status: Active Code APC N ASC N1 Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
F2 Left hand, third digit
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
F1 Left hand, second digit
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
F8 Right hand, fourth digit
F9 Right hand, fifth digit
FA Left hand, thumb
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
T2 Left foot, third digit
T5 Right foot, great toe
T6 Right foot, second digit
T9 Right foot, fifth digit
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
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Notes
2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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