CPT Code 26675: Closed treatment of carpometacarpal dislocation

Key Takeaways

CPT code 26675 covers closed treatment of carpometacarpal dislocation, other than the thumb, with manipulation, requiring anesthesia – each joint billed separately.

The code carries a 90-day global surgery period; E/M visits during that window are bundled unless modifier 24 applies for an unrelated condition.

Never use 26675 for thumb CMC injuries: a pure thumb dislocation bills under 26641, and a thumb fracture-dislocation (Bennett fracture) bills under 26645.

Pabau’s claims management software helps orthopedic and hand surgery practices flag global period conflicts and submit closed reduction claims accurately.

CPT code 26675 is the code hand surgeons and emergency physicians report when they reduce a dislocated carpometacarpal joint by closed manipulation and the patient needs anesthesia to tolerate it.

It sits in a small family of related codes – 26670, 26676, and 26685 – that differ by anesthesia use, added fixation, or an open surgical approach. Picking the wrong one is a common, avoidable audit finding.

This guide covers what CPT 26675 describes, the RVU and Medicare reimbursement figures behind it, the ICD-10 codes that support the claim, how it differs from neighboring codes (including the thumb-specific Bennett fracture codes), and the documentation a payer expects to see before paying the claim.

CPT Code 26675: Definition and clinical description

CPT code 26675 describes closed treatment of carpometacarpal dislocation, other than the thumb, with manipulation, each joint, requiring anesthesia. It applies only when three conditions are met at once: the injured joint is a non-thumb CMC joint, closed manipulation is performed, and anesthesia is required to complete that manipulation.

It is one of the most specific codes in the hand dislocation code family for exactly that reason. Practices relying on structured CPT coding workflows tend to catch the distinction between this code and its adjacent variants before claims go out the door.

The American Medical Association (AMA) maintains CPT 26675 within the Musculoskeletal System subsection covering carpals and metacarpals. The phrase “each joint” in the descriptor is significant: if two non-thumb CMC joints are treated at the same operative encounter, each joint may be billed separately. Payer bilateral policies vary, so confirm coverage rules before reporting multiple units.

Clinical context: Carpometacarpal dislocation

The carpometacarpal joints connect the metacarpal bases to the distal carpal row. Non-thumb CMC dislocations are rare, accounting for roughly 1% of all hand injuries, but they carry significant functional consequences when missed or improperly managed. High-energy trauma – crushing injuries, punching mechanisms, axial loading – drives most of these injuries.

Providers evaluating polytrauma patients from these mechanisms often screen for associated ligamentous injury elsewhere in the body, such as ACL involvement confirmed with the lever sign test, before narrowing focus to the hand. Hand surgeons and emergency orthopedic providers handling these cases frequently serve sports medicine populations where manipulation under anesthesia is the first-line reduction strategy before considering operative fixation.

CPT code 26675 applies specifically when the treating clinician achieves reduction through closed means – no incision, no direct manipulation through an open wound – and anesthesia is required to relax musculature and allow adequate reduction. That anesthesia requirement distinguishes this code from CPT 26670, its closest relative.

Regional blocks, procedural sedation, and general anesthesia all satisfy the “requiring anesthesia” language in the descriptor, provided the anesthesia is documented in the record.

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Key clinical scope for CPT 26675:

• Non-thumb CMC joints (second through fifth metacarpal bases)
• Closed reduction performed – no open surgical approach
• Anesthesia administered and documented for the manipulation
• Dislocation confirmed on imaging (plain radiograph or CT), with no fracture requiring separate fixation
• May be combined with percutaneous pin fixation (CPT 26676) at the same encounter when fixation is added

The Bennett fracture – a fracture-dislocation at the base of the first metacarpal (thumb CMC joint) – is explicitly outside the scope of CPT 26675. Thumb CMC injuries use a separate code pair: a pure dislocation with no fracture codes under 26641, while a fracture-dislocation at the thumb base (the Bennett pattern) codes under 26645.

Billing 26675 for either thumb CMC code is a code-selection error that survives many automated edits but will flag on detailed chart review. Accurate coding for surgical procedures at the procedure level depends on confirming anatomical site before code assignment.

RVU and Medicare reimbursement for CPT code 26675

Relative value units (RVUs) determine Medicare payment under the Resource-Based Relative Value Scale (RBRVS). CPT code 26675 carries a moderate work RVU reflecting the technical skill and time required for closed reduction under anesthesia.

All figures below are national averages; geographic practice cost index (GPCI) adjustments apply in every locality. Use the CMS fee schedule tool to retrieve current year-specific rates for your Medicare Administrative Contractor (MAC) region.

Orthopedic and physical therapy practices managing post-reduction care should note that the 90-day global period covers all routine follow-up after CPT 26675 is reported. Medicare does not pay separately for casting changes, routine X-rays to confirm alignment, or office visits related to the same condition during that window.

State Medicaid rates and commercial payer allowables differ from Medicare; never apply Medicare rates universally without confirming payer-specific fee schedules. When medical necessity is in question, get a signed Medicare waiver on file before the procedure so the practice isn’t left absorbing the cost of a denial.

ICD-10 diagnosis codes used with CPT code 26675

Every claim for CPT code 26675 requires a supporting ICD-10-CM diagnosis code that confirms a carpometacarpal dislocation. The primary codes come from the S63.05x range (dislocation of carpometacarpal joint); S62.31x fracture codes apply only as a secondary diagnosis when a genuine fracture-dislocation is present rather than a pure dislocation.

Laterality and episode-of-care indicators are required in the 7th character position for all of these codes – the same precision required for codes like S63.002D elsewhere in the wrist and hand injury range.

Use 7th character “A” for the initial encounter – the visit at which the reduction procedure (CPT 26675) is performed. Subsequent routine visits during the global period carry 7th character “D.” Bill the initial claim with the full S63.05x dislocation code, including the correct laterality indicator.

Add a secondary S62.31x code only when a genuine fracture accompanies the dislocation. Failure to include a valid dislocation diagnosis from the S63.05x family is one of the top denial reasons for this code family; the diagnosis must always align with the procedure at the same anatomical site, the same principle behind a code like S62.367S.

Related CPT codes: 26675 vs 26670 and others

Selecting the correct code within the 26670-26685 family is where most coding errors occur for carpometacarpal dislocations. The single most common mistake: billing CPT code 26675 when 26670 should have been reported, or vice versa.

The difference is whether anesthesia was administered and documented. If the record does not contain an anesthesia note, 26675 cannot be supported on audit regardless of what the surgeon intended.

The AAPC CPT code lookup provides the full family of adjacent hand and carpal codes with crosswalk data.

When a closed reduction fails and the same surgeon converts to an open procedure at the same encounter, do not report both 26675 and 26685. Report only 26685, the more definitive procedure – NCCI bundling edits enforce this, and violations result in automatic claim rejection.

Documentation requirements for billing CPT code 26675

Fracture and dislocation care claims draw payer scrutiny. The CMS billing article A52767 outlines what documentation must support these treatment codes billed to Medicare, including closed reduction procedures like CPT code 26675. A compliant record must include all of the following elements before the claim goes out.

• Imaging report: Radiograph or CT confirming carpometacarpal dislocation at a non-thumb joint, with laterality noted
• Procedure note: Describes the manipulation technique, position, reduction achieved, and post-reduction alignment confirmation
• Anesthesia record: Type of anesthesia administered, agent, dosing, and provider – this is the single most commonly missing element on audit
• Clinical indication: Documentation that conservative management or simple splinting was insufficient or that closed manipulation was the appropriate first-line intervention
• Post-reduction imaging: Confirmation that acceptable alignment was achieved; if not, the record should reflect the plan (casting for acceptable reduction, escalation for unacceptable)

HIPAA-compliant documentation standards for medical offices require that clinical records support the services billed, the same core principle behind nursing documentation best practices: accuracy, timeliness, and completeness.

Practices using digital procedure documentation tools can build structured note templates that prompt clinicians to capture each required element at the point of care, reducing the risk that a claim is denied months later because an anesthesia note was filed separately from the operative record. The HIPAA compliance guide covers how those records should be stored and transmitted.

Global surgery period and post-operative billing

CPT code 26675 carries a 90-day global surgery period under Medicare. That means the payment for 26675 is intended to cover all routine post-operative management for 90 days following the procedure. During those 90 days, the following services are bundled and cannot be billed separately to Medicare:

• Post-reduction cast applications or changes
• Routine office visits for fracture follow-up (same condition, same provider)
• X-rays to confirm alignment or healing progression at scheduled follow-up visits
• Pin removal when percutaneous fixation (26676) was performed at the same encounter

Two exceptions apply. If the patient develops a new, unrelated condition during the global period, that visit can be billed with modifier 24 (unrelated E/M during a postoperative period). If the original reduction fails and a separate surgical procedure is required during the global window, that new procedure is billed separately with modifier 79 (unrelated procedure during postoperative period).

Modifier 58 applies when a staged or related procedure is planned and performed during the same global period – for example, when open reduction and internal fixation becomes necessary after a failed closed reduction.

Common billing mistakes and how to avoid them

CPT code 26675 is a low-volume, high-specificity code. That combination means coding errors tend to go undetected longer than errors on high-frequency codes. The patterns below account for the majority of claim problems seen with this code on audit.

• Billing 26675 when 26670 is correct: If the procedure note does not document anesthesia, 26675 cannot be justified. Downcode to 26670 before submitting, or obtain a corrected operative note if anesthesia was administered and simply omitted from the original documentation.
• Upcoding to 26685 (open treatment): Some practices bill the open-treatment code for closed procedures to capture a higher RVU. This is a significant upcoding risk. The procedure note must describe a surgical incision to support 26685.
• Reporting 26675 for a Bennett fracture: The thumb CMC joint is explicitly excluded from this code. An ICD-10 code from the thumb-specific dislocation range will not align with 26675, and most clearinghouses will reject the claim on edit.
• Unbundling E/M during the global period: Billing a standard office visit (99213-99215) for routine follow-up during the 90-day global is a bundling violation. Use modifier 24 only when the E/M genuinely addresses a separate, documented condition.
• Missing the “each joint” opportunity: When two non-thumb CMC joints are treated at the same encounter, each qualifies for a separate unit of 26675. Failing to report both leaves reimbursement on the table. Confirm bilateral or multi-joint payer policy before reporting multiple units.

Practices that run their fracture care claims through a dedicated claims management workflow catch most of these errors at the pre-submission stage. Automated edits for code-family mismatches, ICD-10 alignment, and global period conflicts surface problems before they generate denials.

For practices building or improving their orthopedic coding processes, understanding the clinical distinction behind closed vs open reduction helps establish consistent pre-billing quality checks across code families.

Conclusion

CPT code 26675 sits at the intersection of clinical specificity and billing precision. Three conditions must all be present: a non-thumb CMC dislocation, closed manipulation, and documented anesthesia. Miss any one of them and the wrong code goes on the claim.

The 90-day global period adds another layer of complexity for practices that do not proactively track post-reduction follow-up against the operative date.

Pabau’s claims management software gives orthopedic and hand surgery practices the pre-submission edit layer that catches code-family mismatches, ICD-10 alignment errors, and global period conflicts before they become denials. See how it works for your practice management workflows, or book a demo to walk through a live claims workflow.

Continue your research

Coding another anesthesia-dependent procedure? The CPT code 01210 guide breaks down anesthesia billing for an open hip procedure, using the same anesthesia-documentation logic that applies to CPT 26675.

Screening for other joint injuries after high-energy trauma? The Barlow and Ortolani test guide covers technique, interpretation, and referral for a related orthopedic screening exam.

Handling billing for a different specialty? The chiropractic billing cheat sheet lays out the CPT and ICD-10 codes another specialty uses to keep claims clean.

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