for the open palm dupuytren's release it is definetly 26040 as it was of the palm only and i do not see that a graft was done, if a graft was done then use 26121. As for the resection of the metacarpal that code is 26250 x4
the arthroplasty w/ implant im not sure of as the joint was not specified.
hope this helps good luck
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