Wiki Dupuytren Fibromatosis - Palmar Fasciectomy

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yvetteprater

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CPT code 26045 vs 26123. Insurance denying 26123 and 26125 as services billed not documented. Surgeon: In incision was made in the palm of the left hand beginning in the area of the proximal palmer flexion crease in line with the left small finger and extending as Y to V plasty incision towards the metacarpophalangeal joint flexion crease of the left small finger. At the metacarpophalangeal joint flexion crease, the incision was converted into multiple z plasties. Careful dissection was carried through the skin and subcutaneous tissues. Proximally, the pretendinous cord to the left ring finger was identified and released. The cord was traced from proximal to distal towards the ring finger. The Dupuytren tissue was excised and sent as specimen to the pathology lab. Great care... Once this pretendinous cord was excised, the ring finger was easily extended into full extension. Attention was then turned to the small finger. Same wording for small finger. Then he turns to the thumb and makes a separate Y-V plasty incision in the volar aspect of left thumb and across the metacarpophalangeal joint flexion crease. Pretendinous cord was excised. The thumb could be easily passively extended after excision of the Dupuytren cord. The Y-V plasties were converted and the z plasty flaps were rotated. The incisions were all closed. Coded:

26123-F4
26125-F3
26125-FA

They are denying the whole claim. Any help is appreciated.

Quote
 
yvetteprater said:
CPT code 26045 vs 26123. Insurance denying 26123 and 26125 as services billed not documented. Surgeon: In incision was made in the palm of the left hand beginning in the area of the proximal palmer flexion crease in line with the left small finger and extending as Y to V plasty incision towards the metacarpophalangeal joint flexion crease of the left small finger. At the metacarpophalangeal joint flexion crease, the incision was converted into multiple z plasties. Careful dissection was carried through the skin and subcutaneous tissues. Proximally, the pretendinous cord to the left ring finger was identified and released. The cord was traced from proximal to distal towards the ring finger. The Dupuytren tissue was excised and sent as specimen to the pathology lab. Great care... Once this pretendinous cord was excised, the ring finger was easily extended into full extension. Attention was then turned to the small finger. Same wording for small finger. Then he turns to the thumb and makes a separate Y-V plasty incision in the volar aspect of left thumb and across the metacarpophalangeal joint flexion crease. Pretendinous cord was excised. The thumb could be easily passively extended after excision of the Dupuytren cord. The Y-V plasties were converted and the z plasty flaps were rotated. The incisions were all closed. Coded:

26123-F4
26125-F3
26125-FA

They are denying the whole claim. Any help is appreciated.

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Click to expand...
What are the diagnosis codes that were used?
 
I think whoever audited that is looking for 26121 because there is no reference to the PIP, flexor tendons at the PIP being released or the words "release of single digit". In the op note the work looks to be done at the metacarpophalangeal joints. In reading the description while it does say, "Once this pretendinous cord was excised, the ring finger was easily extended into full extension", it isn't clear anything was done farther than MCP. If I was advising the provider and they did 26123, I would say they need to use more "key words" so it's clear what was done. It would be: crossing the IP joint, release of digit, reference to the PIP, flexor tendons at the PIP being released etc.

26121 is fasciectomy of the palm when it's only the palm.
26123 is the palm + digit, it has to be clear that it included the proximal IP joint.
 
The diagnosis code is M72.0

I have a correction to op note documenting the small finger. "through the same incision, the pretendinous cord to the small finger was identified and meticulously dissected free and released proximally. The cord was dissected free from proximal to distal. The multiple Z plasty incisions were carefully retracted and the pretendinous cord was traced all the way passed the proximal interphalangeal joint. The Dupuytren tissue was excised. Great care was taken ...A thorough and meticulous resection was achieved and with passive extension, I could bring the small finger into full extension.

Since he mentions on this finger "proximal interphalangeal joint", would that be coded 26123?
 
yvetteprater said:
The diagnosis code is M72.0

I have a correction to op note documenting the small finger. "through the same incision, the pretendinous cord to the small finger was identified and meticulously dissected free and released proximally. The cord was dissected free from proximal to distal. The multiple Z plasty incisions were carefully retracted and the pretendinous cord was traced all the way passed the proximal interphalangeal joint. The Dupuytren tissue was excised. Great care was taken ...A thorough and meticulous resection was achieved and with passive extension, I could bring the small finger into full extension.

Since he mentions on this finger "proximal interphalangeal joint", would that be coded 26123?
Click to expand...
Yes. That's exactly what it should look like for 26123.
 
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