Wiki Fasciectomy/Contracture/ Partial Palmar


Rothbury, MI
Best answers
Can someone please direct me with the coding. Would you code 26123 and 26125? F8 &F9? Insurance is saying the codes are not supported. Any help is appreciated.

Preoperative diagnosis: Dupuytren's disease right hand with significant MP joint contractures of the ring finger small finger and a PIP joint contracture of the small finger
Postoperative diagnosis: Same
Operation performed: Partial palmar fasciectomy right hand, digital fasciectomy right small finger with contracture release of the MP joints of the right ring finger right small finger and PIP joint contracture release of the small finger

Indications: Significant contractures ring finger and small finger

Procedure: Patient was taken the albumin on 11/10/20 where he was first given a supraclavicular block anesthetic for next his forearm, arm, and hand were prepped and draped in the normal sterile fashion. Next his arm was elevated exsanguinated with an Esmarch bandage and a tourniquet inflated to 250 mmHg. Next an incision was made in his distal palmar flexion crease transversely. Another incision was extended longitudinally toward the mid palm. 2 more incisions were made distally the ring finger 1 ended at the proximal digital crease of the small finger 1 ended at the DIP flexion crease in a Bruner zigzag fashion. I then elevated skin flaps away from the incisions that I had made using a Beaver blade. This was a tedious process in order to elevate the flaps to leave the skin thick enough to survive but thin enough to remove as much disease as possible. Once the skin flaps were elevated I began the dissection from proximal to distal. I first transected the pretendinous cords to the ring and small fingers in the palm and then traced them distally. The nerve vascular bundles were identified including the common digital nerve to the fourth webspace the ulnar digital nerve to the small finger. The radial digital nerve to the small finger and ulnar digital nerve to the ring finger were identified distal to the common digital nerve in the fourth webspace. The radial digital nerve to the ring finger was also located. I then began to dissect the diseased fascia away from the neurovascular bundles taking extreme care not to injure them. The most difficult part of the dissection was the ulnar side of the small finger where the nerve was encased in the Dupuytren's diseased tissue. This was by far the most tedious part of the operation yet I was able to separate the nerves without injuring them. Once I had his the vast majority of the diseased tissue removed I could then fully extend the MP joints of the ring and small finger and fully extend the PIP joint of the small finger. I before closing I irrigated the wound with copious amounts of saline and then used thrombin spray for hemostasis. I then closed the incision with a combination of interrupted and running 5 and on modified horizontal mattress sutures. The patient was then placed in a bulky soft bandage and splint. He tolerated the procedure well and was sent to discharge area in stable condition.