Dupuytren's contracture injection 20550 and perq aponeurotomy 26040 same finger

Hello all!

I am trying to find out if a steroid injection (20550) done on the same finger as needle aponeurotomy (aka percutaneous fasciotomy, 26040) are both billable? My layman's procedure description of 26040 does not include med injection, but there is an NCCI edit. I checked CPT Assistant for 26040 and wasn't able to find any guidance there. Also didn't see anything revealing in NCCI manual.

Any insight or references would be appreciated!

I would be cautious about reporting both 20550 and 26040 on the same finger/date of service.

CPT 26040 describes a percutaneous palmar fasciotomy (needle aponeurotomy) for Dupuytren's contracture. The procedure itself involves repeated needle passes through the fascial cord to release the contracture.
The fact that there is an NCCI edit between 20550 and 26040 suggests CMS considers these services to be components of one another when performed in the same anatomic area on the same date. I was not able to locate any CPT Assistant guidance that specifically states a steroid injection is included in 26040, but the existence of the edit places the burden on the documentation to support that the injection was a distinct, separately reportable service.

My thought process would be:
If the steroid injection was performed into the same Dupuytren's cord/tendon sheath being treated by the needle aponeurotomy, I would not expect separate reimbursement.
If the injection addressed a separate, independently documented condition at a different anatomical site and the NCCI edit allows modifier 59 (or XS, if applicable), there may be an argument for separate reporting.
If both procedures were performed on the same finger for treatment of the same Dupuytren's pathology, I would expect the NCCI edit to prevail unless there is payer-specific guidance stating otherwise.

Have you checked whether the edit is modifier-allowed (indicator 1) or modifier-not-allowed (indicator 0)? That would be the first thing I'd verify before considering separate billing.


Dee Daniels
Founder | Elevare Management Solutions
Revenue Cycle Management Consultant
www.elevaremgmts.com