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Dupuytren's contracture is a condition characterized by the thickening and tightening of the palmar fibrous tissue, which is a result of excessive collagen deposition beneath the skin of the hand and fingers. This condition leads to the development of a flexion contracture, making it challenging or even impossible for the affected individual to fully extend one or more fingers. Although the thickening of the tissue is typically painless, it significantly impacts hand function. The procedure associated with CPT® Code 26341 involves the manipulation of the palmar fascial cord, commonly referred to as Dupuytren's cord, following a specific enzyme injection aimed at weakening this cord. The enzyme injection, which is reported separately under CPT® Code 20527, is administered to facilitate the subsequent manipulation. The patient is required to return for the manipulation procedure the day after the enzyme injection. During this manipulation, the healthcare provider carefully extends the flexed finger, which results in the mechanical breakage of the weakened cord. This manipulation is crucial as it enhances the range of motion of the affected finger(s), thereby improving the patient's ability to use their hand effectively. The use of CPT® Code 26341 is appropriate for reporting the manipulation of a single palmar fascial cord in this context.
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The manipulation of the palmar fascial cord is indicated for patients diagnosed with Dupuytren's contracture, particularly when there is a significant flexion contracture of one or more fingers that impairs hand function. The procedure is performed following a collagenase enzyme injection, which is intended to weaken the fibrous cord, making it amenable to manipulation. This intervention is typically indicated when the contracture limits the ability to fully extend the fingers, thereby affecting daily activities and overall quality of life.
The procedure for manipulating the palmar fascial cord involves several key steps that are critical for achieving the desired outcome. First, the patient returns to the healthcare provider's office the day after receiving the enzyme injection. This timing is essential as the enzyme has had the opportunity to weaken the Dupuytren's cord, making it more pliable. Upon arrival, the healthcare provider assesses the condition of the affected hand and fingers, noting the degree of flexion contracture present. Next, the provider positions the patient's hand in a manner that allows for optimal access to the affected fingers. The manipulation itself involves the careful and controlled extension of the flexed finger(s). The provider applies force to the finger while simultaneously stabilizing the hand, which results in the mechanical breakage of the weakened palmar fascial cord. This manipulation is performed with the goal of restoring a greater range of motion to the affected finger(s), thereby improving the patient's ability to extend their fingers fully. The procedure is typically completed in a single session, and the provider may offer guidance on post-procedure care to ensure optimal recovery.
After the manipulation of the palmar fascial cord, patients may experience some discomfort or swelling in the affected area, which is a normal part of the recovery process. The healthcare provider may recommend specific post-procedure care instructions, including the application of ice to reduce swelling and the use of over-the-counter pain relief medications as needed. Patients are typically advised to engage in gentle range-of-motion exercises to promote healing and maintain flexibility in the fingers. Follow-up appointments may be scheduled to monitor the recovery process and assess the effectiveness of the manipulation. It is important for patients to adhere to the provider's recommendations to ensure optimal outcomes and to address any complications that may arise during the recovery period.
| Short Descr | MANIPULAT PALM CORD POST INJ | Medium Descr | MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD | Long Descr | Manipulation, palmar fascial cord (ie, Dupuytren's cord), post enzyme injection (eg, collagenase), single cord | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 2 | CCS Clinical Classification | 163 - Other non-OR therapeutic procedures on musculoskeletal system |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GZ | Item or service expected to be denied as not reasonable and necessary | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | F9 | Right hand, fifth digit | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GC | This service has been performed in part by a resident under the direction of a teaching physician | F3 | Left hand, fourth digit | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | F1 | Left hand, second digit | F2 | Left hand, third digit | F4 | Left hand, fifth digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | FA | Left hand, thumb | GA | Waiver of liability statement issued as required by payer policy, individual case | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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