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Dupuytren release

  1. #1
    Default Dupuytren release
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    I am re-posting this....anyone have any input?

    Can anyone else please take a look at this op note and tell me if I am coding it correctly"
    Post op Dx: Excision od Dupuytren contracture of left hand
    He has a classic Dupuytren contracture with flexion deformity starting in his proximal interphalageal and metacarpophalangeal joints of his ring finger and metacarpophalangeal joint of the little finger.

    "....I made a multiple Z-tyoe incision initially over both the ring finger and then the little finger. he ring finger was addressed initially. There was a large band from the proximal palm that was dissected with stirrup dissection under loupe magnification and followed out to the level of the middle phalanx. This was dissected almost in toto and sent for path exam. I was then able to bring the proximal interphalangeal and metacarpophalangeal joints easily into full extension. I then started the skin repair, and at the level of the metaca. joint, the skin was rather tight. I , therefore, performed a Z-plasty in the skin at this level and then was able to achieve satisfactory closure with undue strain on the skin. I then made an incision in, again, a multiple Z-type incision down the little finger on the palmar aspect into the palm. Again, one large band from the palm was resected, and then this was followed out into the proximal phalangeal level of the little finger. There was a large nodule in this area that was excised and then several smaller bands were also resected. The digital nerve was identified and was intact. The wound was closed...."


    3M keeps coming back with 26045 for open release of contracture. Is that what I should go with instead? Does the excision of the nodule in the area of the little finger count as incidiental to the procedure?

    Does any one agree/disagree? Any help is appreciated. Thanks

  2. #2
    Indianapolis, Indiana
    I'm fairly new to Ortho Surgery,but I would agree with your choices of 26121 & 26125. 26045 looks like the palmar fascia is just "incised" to release the contracture. In 26121 & 26125 the palmar fascia is removed. He stated was removed "almost in toto". 26123 is partial palmar with release of single digit, including the PIP joint.

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