Wiki 26123-F3 for Dupuytren's contracture ++

[jsz123]

Any hand specialist coders that can assist me with this ortho case please? (just a bit overwhelmed with this one)

PROCEDURE:
1. Release of left ring finger Dupuytren's contracture.
2. Release IP joint, left ring finger.
3. Release intrinsic tightness/central slip, left ring finger.

Approximately 4 cm Brunner type incision was made from the DIP crease into the mid palm. Dissection was taken down and we spent approximately 25 minutes meticulously dissecting out both the radial and ulnar digital nerves from the palm out to the distal aspect of the finger. The underlying flexor tendons were identified, and protected. We very carefully dissected out the A2 and the A4 pulleys, which were protected. The Dupuytren's cord was excised from the palm including several contractures, the cord, and a small nodule, all the way from the palm to the level of the distal aspect of the middle phalanx. Once we had completely excised all the Dupuytren's, attention was then turned to the PIP joint release.

The A5 pulley was opened, and dissection was taken down through the A5 pulley to the PIP joint. The PIP joint was exposed by excising a portion of the volar plate. With the volar plate exposed. I was still unable to extend the finger. For this reason, collateral ligaments, both on the radial and ulnar side were released from the distal aspect of the middle phalanx. At this point, I was able to get the finger into full extension, without difficulty. She still did have a significant boutonniere's deformity, and for this reason, approximately 0.5 cm incision was made over the dorsal aspect just proximal to the PIP joint. This did significantly improve our flexion. We had full extension of both the PIP joint, and full flexion of the DIP joint, but she still lacked some active extension. I think this is likely secondary to lengthening of the extensor tendons, and she was able to extend the finger quite well with the wrist in a flexed position. I elected at this point, however, to pin the PIP joint in extension. This was performed from the ulnar side with a single 0.045 K-wire under direct visualization. At this point, the PIP joint was straight. Wounds were then copiously irrigated, closed loosely with 4-0 nylon suture. There was no need for Z-plasty, or soft tissue rearrangement.

 

[nickelclaw]

release of dupuytren's contracture (fascia of hand), fasciectomy (excision of Dupuytren's), with release partial of finger(goes by how many)
in this case just one ring finger along with the release of hand/palm contracture of same finger code is 26123-LT with dx M72.0
Here is a description from coders desk reference:
26121-26125

The physician removes the palmar fascia. The physician incises the overlying skin and subcutaneous tissue. The palmar fascia is exposed and resected. Tendon sheaths are freed. The incision is sutured in layers if possible. Z-plasties are performed or skin grafts are obtained to close the wound if necessary. In 26121, the palmar fascia is removed. In 26123, part of the palmar fascia is removed and flexor tendons at proximal interphalangeal joints are released. Use 26125 to report additional digits.

for the boutonniere's deformity which is a separate procedure M20.022
Boutonniere deformity repair (extensor tendon of finger) 26426-F3 if a graft was used it would be 26428
Here is description from coders desk reference:
26426-26428

The physician repairs a Boutonniere, or buttonhole, deformity of the central slip extensor tendon with a soft tissue procedure that reconstructs the central slip using the lateral band in 26426 or a free tendon graft in 26428. In this deformity, the tendons are imbalanced due to synovitis in the proximal interphalangeal (PIP) joint that causes a stretching of the central slip and subluxation of the lateral bands, which become tight from the swollen joint pressure and act as flexors to the PIP joint. This causes hyperextension deformities in the distal interphalangeal and metacarpophalangeal joints. The physician makes a dorsal, longitudinal incision over the proximal interphalangeal joint to the distal IP joint. The displaced lateral bands are mobilized and a tenotomy is done on the two lateral tendons next to the distal IP joint. The functionality of the central tendon must be restored. The lateral bands are aligned with the central tendon and used as local tissue to reconstruct the central slip. Report 26428 if a separate free tendon graft must be harvested to repair the central slip. A synovectomy is done. Tendon balance must be assured before the proximal IP joint is fixed in extension. The finger is later placed in a dynamic extension splint after removal of the fixation wire.

 

[jsz123]

release of dupuytren's contracture (fascia of hand), fasciectomy (excision of Dupuytren's), with release partial of finger(goes by how many)
in this case just one ring finger along with the release of hand/palm contracture of same finger code is 26123-LT with dx M72.0
Here is a description from coders desk reference:
26121-26125

The physician removes the palmar fascia. The physician incises the overlying skin and subcutaneous tissue. The palmar fascia is exposed and resected. Tendon sheaths are freed. The incision is sutured in layers if possible. Z-plasties are performed or skin grafts are obtained to close the wound if necessary. In 26121, the palmar fascia is removed. In 26123, part of the palmar fascia is removed and flexor tendons at proximal interphalangeal joints are released. Use 26125 to report additional digits.

for the boutonniere's deformity which is a separate procedure M20.022
Boutonniere deformity repair (extensor tendon of finger) 26426-F3 if a graft was used it would be 26428
Here is description from coders desk reference:
26426-26428

The physician repairs a Boutonniere, or buttonhole, deformity of the central slip extensor tendon with a soft tissue procedure that reconstructs the central slip using the lateral band in 26426 or a free tendon graft in 26428. In this deformity, the tendons are imbalanced due to synovitis in the proximal interphalangeal (PIP) joint that causes a stretching of the central slip and subluxation of the lateral bands, which become tight from the swollen joint pressure and act as flexors to the PIP joint. This causes hyperextension deformities in the distal interphalangeal and metacarpophalangeal joints. The physician makes a dorsal, longitudinal incision over the proximal interphalangeal joint to the distal IP joint. The displaced lateral bands are mobilized and a tenotomy is done on the two lateral tendons next to the distal IP joint. The functionality of the central tendon must be restored. The lateral bands are aligned with the central tendon and used as local tissue to reconstruct the central slip. Report 26428 if a separate free tendon graft must be harvested to repair the central slip. A synovectomy is done. Tendon balance must be assured before the proximal IP joint is fixed in extension. The finger is later placed in a dynamic extension splint after removal of the fixation wire.

Thank you so much for your answer! (I did not see your post until just now so I apologize about the lateness of this reply). I appreciate the reference material also.

FYI, I ended up utilizing the Ask An Expert resource through AAPC for guidance after not seeing a reply for a week. I was told that 26123 included all of the above. Ack, now I am wondering if I left some $ on the table.