APRIL 2016

Dupuytren’s Contracture Release

Dupuytren’s contracture is defined as thickening and tightening of the palmar fascia which causes a flexion deformity of the fingers (bending of the finger towards the palm). The two most commonly affected fingers are the ring and small fingers.

Starting with the minimally invasive procedures there are two types of services, the first is an injection and the second is a percutaneous. The injection procedure is reported with CPT code 20527 and per CPT coding guidelines when multiple cords are treated you should report 20527 for each cord treated, however there are carriers such as Medicare that will only allow treatment of one cord at a time so confirm your individual carrier's policy. After the injection has been performed the patient returns on a subsequent day for manipulation of the treated cord and this would be reported with CPT code 26341 for each individual cord that is manipulated.

A percutaneous palmar fasciotomy is reported with CPT code 26040 and is usually achieved by making a stab incision through the skin to release the contracted cord. Another type of percutaneous procedure is called a needle aponuerotomy which is considered medically necessary by some carriers for the treatment of Dupuytren’s contracture so again, confirm the carrier’s policy for this type of service.

Next is the open palmar fasciotomy where the physician will make an incision through the skin and subcutaneous tissue dissecting down to the cord which is then incised to release the contracture. There is a CPT Assistant article stating that CPT codes 26040 and 26045 may only be reported once per hand and if a fasciectomy is performed then a code from the 26121-26125 series should be reported.

With that being said we will now discuss the fasciectomy procedures 26121-26125. There is one major difference that the coder should look for in the documentation when reporting 26121 fasciectomy “palm only” and 26123 “partial palmer with release of single digit, including proximal interphalangeal joint”. In 26121 the physician can excise the palmar fascia (fasciectomy) which in turn will allow the affected finger to extend back into its normal position but the procedure was only performed in the palm therefore you should report 26121.

In 26123/26125 the physician not only performs the palmar fasciectomy but they must also document that the dissection continued up into the finger and that the proximal interphalangeal joint was released. Just releasing the cord without any work performed in the finger would not justify the use of 26123.

 







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