Wiki Fasciectomy

adunlap23

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I have a doctor who likes to pre-code his op reports. I recently reviewed a report in which he performed three fasciectomies of the same hand for Dupuytren's Contracture.
He has it coded as:
26123-left hand fasciectomy of the palm fifth ray and small finger
26121-left hand fasciectomy of the first webspace
26121-left hand fasciectomy of the third ray
My question is, how many fasciectomies can be coded per hand? I thought only one but he is coding per excision. Does anyone know the rule for these procedures? I can't seem to find any resources clarifying how to code them properly.
 
When coding these I have found coders often mix up fasciECTOMY vs. fasciOTOMY. So, that's always step one is to make sure you have that part down when looking at 26045 vs. the 2612_ area.

When it's fasciectomy as you have above you are left with the 26121-26125 area. I can't tell from the minimal info above exactly which codes without seeing the whole op note. You definitely can't report 26123 or 26121 more than once. And, you can't report 26121 & 26123 together for the same hand due to NCCI and it does not make sense. If additional digits are released more than 26123 it's add on 26125. It's the difference between palm only (26121) and palm with release of the digit (26123). What you have above looks like 26123 only. But, would need the whole op note to make sure.
To report 26123, AMA Vignette says the cord is dissected out along the whole length up to the middle phalanx which means they have to cross the IP joint. So I would have to see if that was the case.

When asking about how many times you can code per you would need to look up the MUEs. This goes for anytime you aren't sure of the # you can report per day. This is just one link to a lookup tool for that: https://www.cgsmedicare.com/medicare_dynamic/j15/mue/mue_tool.aspx
The MUE for 26123 is 1
The MUE for 26121 is 1
The MUE for 26125 is 4

If you were reporting 26040 or 26045 for fasciotomy CPT Assistant June 2011 states you only code that once per hand.

This can all be looked up with using the CPT definitions themselves, the MUE tool, CPT Assistant and AMA Vignette.
Doctor's coding their own op notes is scary :)
 
When coding these I have found coders often mix up fasciECTOMY vs. fasciOTOMY. So, that's always step one is to make sure you have that part down when looking at 26045 vs. the 2612_ area.

When it's fasciectomy as you have above you are left with the 26121-26125 area. I can't tell from the minimal info above exactly which codes without seeing the whole op note. You definitely can't report 26123 or 26121 more than once. And, you can't report 26121 & 26123 together for the same hand due to NCCI and it does not make sense. If additional digits are released more than 26123 it's add on 26125. It's the difference between palm only (26121) and palm with release of the digit (26123). What you have above looks like 26123 only. But, would need the whole op note to make sure.
To report 26123, AMA Vignette says the cord is dissected out along the whole length up to the middle phalanx which means they have to cross the IP joint. So I would have to see if that was the case.

When asking about how many times you can code per you would need to look up the MUEs. This goes for anytime you aren't sure of the # you can report per day. This is just one link to a lookup tool for that: https://www.cgsmedicare.com/medicare_dynamic/j15/mue/mue_tool.aspx
The MUE for 26123 is 1
The MUE for 26121 is 1
The MUE for 26125 is 4

If you were reporting 26040 or 26045 for fasciotomy CPT Assistant June 2011 states you only code that once per hand.

This can all be looked up with using the CPT definitions themselves, the MUE tool, CPT Assistant and AMA Vignette.
Doctor's coding their own op notes is scary :)
This was helpful. I don't have access to CPT Assistant or AMA Vignette. I did check the MUE and and guidelines, but I read too much into things and then question my understanding. Thank you for your help. Sometimes I just need someone to verify that my understanding is correct.
Thanks again!
 
This was helpful. I don't have access to CPT Assistant or AMA Vignette. I did check the MUE and and guidelines, but I read too much into things and then question my understanding. Thank you for your help. Sometimes I just need someone to verify that my understanding is correct.
Thanks again!
this is normal. I think we all second-guess ourselves sometimes. Coders tend to be very detail oriented and can get into our own heads. Asking for a second pair of eyes goes with the territory.
:)
 
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