# dupuytren'scontracture???



## codedog (Nov 18, 2010)

what is difference between  cpt code  and  26045  &  26121-26125
 looking  tthis procedure I want to code 26123?and 64702?may be wrong 



PREOPERATIVE DIAGNOSIS:  Right long finger Dupuytren's contracture.   
POSTOPERATIVE DIAGNOSIS:  Right long finger Dupuytren's contracture.   
OPERATIONS PERFORMED:  Dupuytren's contracture release, with excision of Dupuytren's tissue, fasciectomy of the palm, and neuroplasty of the radial and ulnar digital nerves to the long finger.        

 PROCEDURE IN DETAIL:
 gentleman with a right Dupuytren's contracture that he has noticed some worsening.  After appropriate consent was obtained, the site was marked, and he was brought to the operating suite.  His right upper extremity was prepped and draped in the normal sterile fashion.  After general anesthesia was instituted without difficulty, antibiotics were given.  The tourniquet was inflated to 250 mmHg.  Time out was called.  A zigzag incision was made in the palm in line with some of the skin creases.  The skin flaps were elevated full thickness and sutured to open up the hand.  It was placed in the _____ hand for additional retraction.  The Dupuytren's tissue was dissected circumferentially and proximally and released with a 15 blade.  The neurovascular structures were identified during this process, and meticulous dissection around the Dupuytren's contracture and the neuroplasties performed of the radial and ulnar digital nerves all the way to the proximal extent of the digit to ensure that it was not caught up in the Dupuytren's tissue.  The flexor tendon was also identified, and the Dupuytren's tissue was excised as one unit and sent to Pathology for evaluation.  The radial and ulnar digital nerves were again confirmed to be intact as was the tendon.  The wound was copiously irrigated.  Closure was with a 4-0 nylon suture followed by bulky soft dressing on the finger and an extension splint.  There were no complications.   
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## purinoski (Nov 18, 2010)

26123  is correct.  64702 is bundled into 26123 because doc would be checking for nerve impingement anyway.  You can check the CCI edits.  Hope this helps


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## skorkfranks (Nov 18, 2010)

According to the 2010 Coding Companion:

"The physician incises the palmar fascia to release a Dupuytren's contracture. A Dupuytren's contracture is a shortening of the palmar fascia resulting in flexion deformity of a finger. In 26045, the subcutaneous tissue is incised and retracted to expose the palmar fascia. The palmar fascia is incised to relieve tension and allow the hand to extend correctly. The operative wound is sutured in layers."

26121-26125 - "The physician removes the palmar fascia. The physician incises the overlying skin and subcutaneous tissue. The palmar fascia is exposed and resected. Tendon sheaths are freed. The operative incision is closed in surtured layers if possible. Z-plasties are performed or skin grafts are obtained to close the wound if necessary. In 26121, the entire palmar fascia is removed. In 26123, part of the palmar fascia is removed and flexor tendons at proximal interphalangeal joints are released."

Hope this was helpful.


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