Mjohnstone
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I am trying to figure out if it is possible to bill 26045 and 26125 together. I can't find any documentation that this is not possible. Medicare has denied my claim for Related or qualifying claims/service was not identified on this claim. I did do a reopening to add the finger modifier for 26125 and attached the note. I ran the claim information through Clear Claim Connection with no problems. The diagnosis code is M72.0. The CPT's for the reopening looked like this - 26045, 26152-59-F2.
OP Note
Bruner incision was made on the fifth digit. we elevated the full-thickness skin flaps and grasp each corner. We exposed the significant amount of Dupuytren's pathological fascia. It was most significant and adherent to skin near the distal palmar crease and the PIP joint flexion crease. Care was taken to identify neurovascular bundles and then traced them distally. They were pulled to the midline out of the normal anatomic plane by the diseased tissue. Once the digital neurovascular bundles were exposed, the proximal portion of the cord was cut and released and then the pathologic tissue was reflected distally. At the PIP flexion crease, was once again entanglement of the digital neurovascular bundles with diseased fascia, so again once the plane was created the diseased tissue was elevated up off the flexor tendon sheath. We also found separate cord emanating from the abductor digiti minimi tendon and this too was resected and released. this left us with about a 10 degree or so flexion contracture of the PIP joint itself. I gently stretched the finger and felt that with the small degree of contracture, it could probably improve the longer-term splinting and I opted not to open the joint capsule to release the collateral ligaments nor release the volar plate.
And then turned turned our attention to the cord affecting the MCP of the middle finger. A transverse incision was made in the skin at about the level of the mid palmar crease. We exposed the significantly thick fascia here in the palm and very gently cut down through its depth while stretching the finger into full extension. Care was taken to protect the flexor tendons below. Finger came into full extension.
Thank you for any input.
OP Note
Bruner incision was made on the fifth digit. we elevated the full-thickness skin flaps and grasp each corner. We exposed the significant amount of Dupuytren's pathological fascia. It was most significant and adherent to skin near the distal palmar crease and the PIP joint flexion crease. Care was taken to identify neurovascular bundles and then traced them distally. They were pulled to the midline out of the normal anatomic plane by the diseased tissue. Once the digital neurovascular bundles were exposed, the proximal portion of the cord was cut and released and then the pathologic tissue was reflected distally. At the PIP flexion crease, was once again entanglement of the digital neurovascular bundles with diseased fascia, so again once the plane was created the diseased tissue was elevated up off the flexor tendon sheath. We also found separate cord emanating from the abductor digiti minimi tendon and this too was resected and released. this left us with about a 10 degree or so flexion contracture of the PIP joint itself. I gently stretched the finger and felt that with the small degree of contracture, it could probably improve the longer-term splinting and I opted not to open the joint capsule to release the collateral ligaments nor release the volar plate.
And then turned turned our attention to the cord affecting the MCP of the middle finger. A transverse incision was made in the skin at about the level of the mid palmar crease. We exposed the significantly thick fascia here in the palm and very gently cut down through its depth while stretching the finger into full extension. Care was taken to protect the flexor tendons below. Finger came into full extension.
Thank you for any input.