CPT Codes for Dupuytren Contracture Treatments
By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
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Dupuytren contracture is a condition that affects the palmar fascia in the hand, leading to the thickening and shortening of the fascia. This results in the formation of knots of tissue that can progress into cord-like structures, causing the fingers to become contracted towards the palm, primarily affecting the ring and small fingers.
There are several treatment options for the disease, ranging from surgical interventions like Fasciectomy and Fasciotomy to injection therapies such as Xiaflex. Understanding the nuances of each procedure and unique payer guidelines are vital to ensure reimbursement.
In this blog post, we’ll review the corresponding CPT codes for Dupuytren contracture treatments.
Excision of the Cord (CPT Code 26121)
The standard surgical technique for treating Dupuytren involves excision of the cord in the palm.
This procedure, known as Fasciectomy, is reported with CPT code 26121.
It may include Z-plasty, local tissue rearrangement, or skin grafting if required.
Partial Palmar Fasciectomy (CPT Code 26123)
In severe cases where the cord extends from the palm into the finger with significant finger contracture, Fasciectomy may be performed.
CPT code 26123 is used for partial palmar fasciectomy with release of single digit, including the proximal interphalangeal joint (PIP).
Additional digits are reported with code 26125.
It’s crucial to ensure that the procedure involves excising the cord up into the finger and releasing the PIP joint.
Fasciotomy (CPT Codes 26045, 26040)
An alternative surgical option is Fasciotomy, where the physician incises the fascia rather than excising it.
This can be performed as an open procedure (CPT code 26045) or percutaneously (CPT code 26040).
Percutaneous techniques may include needle aponeurotomy, which involves multiple needle insertions into the fascia to release the contracture. Some insurers, like Aetna, consider needle aponeurotomy medically necessary for Dupuytren contracture under specific conditions.
Coding for Collagenase Clostridium Histolyticum (CCH) Injections
Lastly, there is the injection procedure Collagenase Clostridium Histolyticum (CCH), more commonly known as Xiaflex.
This is a two-stage procedure in which Xiaflex is injected into the cord on one day and reported with CPT code 20527 Injection, enzyme (collagenase), palmar fascial cord (Dupuytren contracture), to help dissolve/breakdown the cord.
The patient then returns on a different day for manipulation to break up the contracture, which is reported with CPT code 26431 Manipulation, palmar fascial cord (Dupuytren cord), post enzyme injection.
Many carriers consider this service as medically reasonable and necessary but may have different coverage guidelines and limitations, so it is best to confirm payer policies to ensure reimbursement.
Don’t forget that you can bill separately for Xiaflex using HCPCS code J0775 Injection, collagenase, clostridium histolyticum, 0.01 mg, a code that is found on the ASC List and reimbursed by Medicare.