Utilization Review Checklist
Mallet Finger
Derived from the ACOEM Hand, Wrist and Forearm Disorders Guideline, edition 14 July 2025, as adopted into the California MTUS 2 January 2026. CPT 26765, 26746. ICD-10 S62.63, M20.01.
Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.
CriteriaCheck if documented
Confirmatory Diagnosis
Required
Displaced fracture involving more than one third to one half of the articular surface of the DIP joint
“Surgical treatment with a fixation wire is recommended for patients with displaced fractures involving more than one third to one half of the articular surface of the DIP joint.” — p. 385
Surgical Considerations (fixation wire)
Required
Fixation with a wire requested
“Surgical treatment with a fixation wire is recommended for patients with displaced fractures involving more than one third to one half of the articular surface of the DIP joint.” — p. 385
Procedures — the guideline treats each separately
Surgical treatment with a fixation wire for mallet finger with a displaced fracture
Recommended.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence moderate
A proportion, not a measurement: the fracture must involve MORE THAN ONE THIRD TO ONE HALF of the articular surface of the DIP joint. Get that proportion into the radiology report or state your own assessment of it — a mallet finger without a displaced fracture of that size is treated by splinting.