Orthopedic Coding Alert

Watch your surgeon's documentation for clues regarding partial or complete treatment and the number of digits involved, and you'll be on your way to clean Dupuytren contracture release claims every time.

What happens: Dupuytren contracture release involves excising contracted fibrotic bands of the palmar fascia. Surgeons can either use a standard open incision with fasciectomy (known as the McCash technique) or percutaneous fasciotomy (known as the Luck technique),says Janet Vanderpuije with OrthoMaryland in Baltimore. Here's how to break down these techniques into coding realities.

If the surgeon completes fasciotomy to treat Dupuytren's contracture (728.6, Contracture of palmar fascia), check the operative notes for whether he used an open or percutaneous approach. Then, choose between 26040 (Fasciotomy, palmar [e.g., Dupuytren's contracture]; percutaneous) or 26045 (... open, partial) and report the correct code for each finger the surgeon treats.

Extra codes: Your orthopedist can perform percutaneous or minimally invasive treatment of Dupuytren's contracture in an office setting, which means you'll need to report additional codes. Report 26040 for the procedure, along with the appropriate E/M choice. Because of the work involved, your most likely options are 99203 (Office or other outpatient visit for the evaluation and management of a new patient ...) or 99213  (Office or other outpatient visit for the evaluation and management of an established patient ...).

The most common type of percutaneous treatment is needle aponeurotomy, or NA. The physician uses the tip of a hypodermic needle as a very small knife to divide the contracting cords of Dupuytren's disease.

Your surgeon might opt for fasciectomy to treat more extensive cases of Dupuytren's contracture. Base your codes on whether he completes a palm-only procedure or also accesses the digits:

26121 -- Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)

26123 -- Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft).

When reporting 26123, append +26125 (... each additional digit [List separately in addition to code for primary procedure]) as needed. Code "26125 is an add-on code required to identify each additional digit," says Gloria Moran, practice manager for Jacksonville Orthopaedic Institute, University Division, in Florida. CPT directs you to report +26125 with 26123. Because 26121 applies to palm-only procedures, you don't need codes specifically for digits.

Tip: When coding these cases, you're looking at "otomy" versus "ectomy," Moran adds. "If coders will watch for the wording, they'll know which codes to use," she says.