Orthopaedic/dupuytrens contracure codes

barelybe

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HOW WOULD YOU CODE?

1.FOURTH RAY PARTIAL FASCIECTOMY LEFT HAND
2.FIFTH RAY PARTIAL FASCIECTOMY LEFT HAND
3.FOURTH DIGIT PARTIAL FASCIECTOMY LEFT HAND
4.FIFTH DIGIT PARTIAL FASCIECTOMY LEFT HAND

Brunner zigzag incision made from the ulnar mid palm at the distal carpal tunnel distalward towards the fourth digit and over the fourth and fifth rays extended onto the fourth digit. The incision was extended to the fourth digit middle phalanx base and a separate incision was then made in a zigzag fashion over the palmar fifth digit to the base of middle phalanx level...
26123x1 26125x1 26121x1?????
 

AlanPechacek

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Your physician seems to be doing some "unbundling" of his procedure by separating the palmar portions of the procedure from the digital portions. Code 26121 applies to "palm only" fasciectomy for Dupuytron's Contracture. Code 26123 includes the palmar and digital portions of the procedure (out to the PIP joint), i.e. excision of the palmar fascia and release of contractures of the PIP Joint. I would apply this to the 4th ray and digit. Code 26125 is an Add On Code to 26123 for the additional digit, in this case the 5th, and includes the palmar and digital portions of the procedure, even though he made a secondary incision on the palmar side of the small finger to release the contracture of the 5th PIP Joint. Therefore, you can use 26123 x 1, and 25125 x 1.

Respectfully submitted, Alan Pechacek, M.D.
 

daedolos

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Does the Dx of M72.0 satisfy the requirements for 26123 or does a more specific Dx apply? In my case, the treatment was for middle and ring finger contractures. I don't see what else to use because the trigger finger codes. Would M65.331 and M65.341 apply?

Peace
?_?
Thank you in advance.
 

AlanPechacek

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Code M72.0: Palmar fibromatosis (Dupuytren's Disease) covers it all regardless of the extent or severity of the disease in the palm and/or fingers. That is the only code in ICD-10 for the disease. M65.3 _ is for Trigger finger(s)/thumb, which is a type of "tendinitis/tenosynovitis" disorder of the flexor tendons, and is an entirely different animal from Dupuytren's.

Hope this helps clarify this for your and any others.

Sincerely, Alan Pechacek, M.D.
 
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