Trigger Finger Release

CPT 26055
Approach Open
Add-on / Variant CPTs
  • 26040 — Fasciectomy, palmar, Dupuytren contracture (if concurrent)
  • 64721 — Neuroplasty, median nerve (if carpal tunnel release added)
  • 20550 — Injection, tendon sheath (if steroid injection at separate session)
Preoperative Diagnosis:

Stenosing tenosynovitis (trigger finger), [right / left] [thumb / index / middle / ring / small] finger

Postoperative Diagnosis:

Same

Procedure Performed:

Open A1 pulley release, [right / left] [thumb / index / middle / ring / small] finger

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/PA name]

Anesthesia:

[Local with sedation / wide-awake local / digital block]

Indications:

Patient presents with [painful triggering / locking / snapping] of the [right / left] [thumb / ring] finger consistent with stenosing tenosynovitis. [Conservative management including steroid injections has failed / Patient declined further injections.] [Graded [II / III / IV] triggering.] Decision made to proceed with surgical A1 pulley release. Risks including digital nerve injury, incomplete release, stiffness, infection, and bowstringing discussed. Consent obtained.

Findings:

Thickened and constricted A1 pulley over the [finger] flexor tendon sheath. [Flexor tendons intact.] [Nodule palpable on tendon / tendon smooth after release.] Complete triggering resolution confirmed with passive flexion-extension after release.

Description of Procedure:

The patient was positioned supine with the [right / left] hand on a hand table. [Digital block / local infiltration / wide-awake local anesthesia with lidocaine and epinephrine] was administered. The hand was prepped and draped in sterile fashion. [A tourniquet was inflated at the wrist level / No tourniquet used with wide-awake technique.]
A [longitudinal / transverse] incision of approximately 1.5 cm was made over the [A1 pulley] at the [MP flexion crease] of the [ring] finger. Dissection was carried through the skin and subcutaneous tissue. The digital neurovascular bundles were identified and protected. The A1 pulley was identified and divided longitudinally with a [15-blade / tenotomy scissors] from its proximal to distal extent. The flexor tendons were visualized — [FDS and FDP intact, tendon surface smooth, no nodule]. Passive and active flexion-extension confirmed complete release without triggering.
[Tourniquet released — hemostasis achieved.] Wound irrigated. Skin closed with [4-0 Nylon / 3-0 Monocryl]. Sterile dressing and hand dressing applied. Patient tolerated the procedure well.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

Patient taken to PACU in stable condition. Discharged to home with hand therapy instructions.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Stenosing tenosynovitis (trigger finger), [right / left] [thumb / index / middle / ring / small] finger
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Open A1 pulley release, [right / left] [thumb / index / middle / ring / small] finger
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: [Wide-awake local / digital block / local with sedation]

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with [painful triggering / locking] of the [right / left] [thumb / ring] finger consistent with stenosing tenosynovitis, grade [II / III / IV]. [Conservative management including steroid injection has failed.] Risks including digital nerve injury, incomplete release, stiffness, and infection were discussed. Informed consent obtained.

FINDINGS: Thickened, constricting A1 pulley over the [finger] flexor tendon sheath. Flexor tendons intact; tendon surface smooth after release. Complete release confirmed with passive and active flexion-extension — no triggering.

DESCRIPTION OF PROCEDURE:
Patient supine; [right / left] hand on hand table. [Wide-awake local anesthesia with lidocaine and epinephrine / Digital block] administered. Hand prepped and draped sterile. [Tourniquet inflated at wrist.] Transverse/longitudinal *** cm incision over A1 pulley at MP flexion crease. Dissection through subcutaneous tissue; digital neurovascular bundles identified and protected. A1 pulley divided longitudinally with 15-blade from proximal to distal extent. FDS and FDP visualized — intact, smooth. Passive and active range of motion confirmed complete release without triggering. [Tourniquet released — hemostasis confirmed.] Skin closed with 4-0 Nylon. Sterile dressing applied. Patient tolerated the procedure well.

ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: None
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to PACU. Discharged home with hand therapy instructions.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Percutaneous release

Needle tenotomy at A1 pulley using 18-gauge needle under ultrasound or palpation guidance. Same CPT 26055. Document needle approach, tendon integrity, and post-procedure triggering resolution. Avoid in thumb (radial digital nerve risk).

Multiple digits, same hand

Bill 26055 for first digit and modifier -51 for each additional. Document each digit released separately with individual findings and release confirmation.

Thumb trigger (stenosing tenosynovitis of thumb)

CPT 26055 applies to the thumb as well. Extra care with radial digital nerve on the radial side of the A1 pulley. Document nerve identification and protection explicitly.

Charting Tips
  • State which digit(s) released and laterality
  • Document digital nerve identification and protection
  • Note tendon integrity after release (FDS, FDP, no nodule, no rupture)
  • Confirm complete release with active and passive range of motion in the operative note
  • Document tourniquet use or wide-awake technique
  • Grade of triggering preoperatively useful for documentation (Quinnell classification)
Billing Tips
  • Bill 26055 for tendon sheath incision (trigger finger release, open A1 pulley) at a single digit (3.03 wRVU, 90-day global). This covers the A1 pulley release regardless of which digit is treated. Document which finger(s) were released.
  • Multiple trigger finger releases at the same session: bill 26055 for the first digit and append modifier -51 (multiple procedures) for each additional digit on the same hand. Some payers reduce payment 50% for modifier -51 procedures, so verify payer rules. Each additional digit should be documented and CPT reported separately.
  • Percutaneous trigger finger release, when performed, uses the same CPT code 26055. The approach (open vs. percutaneous) does not change the code, but document the technique used.
  • Steroid injection at the same session as release is generally not separately billable, as it is considered part of the procedure. Do not add-code 20550 (injection, tendon sheath) when performing surgical release on the same day.
  • 90-day global period: hand therapy, splinting, and routine follow-up visits are bundled. Document range of motion and triggering resolution at the postoperative visit, as this serves as a functional outcome measure.