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Official Description

Excision of constricting ring of finger, with multiple Z-plasties

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Excision of constricting ring of finger, with multiple Z-plasties, is a surgical procedure aimed at addressing constriction ring syndrome, a congenital condition characterized by fibrous bands that can encircle the fingers of a developing fetus. These fibrous bands, originating from the amniotic sac, can lead to significant complications, including swelling, impaired lymphatic or venous flow, and hindered development of the affected digit. The procedure involves making a zigzag incision in the skin over the constricting ring, which allows for the careful excision of the fibrous tissue that is causing the constriction. Following the removal of this tissue, the skin is meticulously rearranged to facilitate the closure of the resulting surgical defect, thereby restoring normal function and appearance to the finger. This intervention is crucial for preventing further complications and promoting healthy development of the digit.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for the treatment of constriction ring syndrome, which may present with the following conditions:

  • Constriction Ring Syndrome A congenital disorder where fibrous bands wrap around the fingers, potentially leading to complications such as swelling and impaired blood flow.
  • Swelling of the Digit The presence of fibrous bands can cause significant swelling in the affected finger, necessitating surgical intervention.
  • Impaired Lymphatic or Venous Flow The constricting bands may obstruct normal lymphatic or venous circulation, which can lead to further complications if not addressed.
  • Developmental Interference The fibrous bands can interfere with the normal growth and development of the digit, warranting surgical excision to promote proper function.

2. Procedure

The procedure consists of several critical steps to ensure effective excision and reconstruction of the affected finger:

  • Step 1: Preparation The patient is positioned appropriately, and the surgical site is cleaned and sterilized to minimize the risk of infection. Anesthesia is administered to ensure the patient is comfortable and pain-free during the procedure.
  • Step 2: Incision A zigzag incision is made in the skin over the constricting ring. This specific incision pattern is chosen to allow for optimal skin tension and to facilitate the subsequent closure of the surgical site.
  • Step 3: Excision of Fibrous Tissue The constricting fibrous tissue is carefully excised. This step is crucial as it removes the source of the constriction, thereby alleviating the symptoms associated with the syndrome.
  • Step 4: Skin Rearrangement After the excision, the surrounding skin is rearranged to allow for the closure of the surgical defect. This may involve additional Z-plasties to ensure that the skin can be sutured without tension, promoting better healing and aesthetic outcomes.
  • Step 5: Closure The incision is closed using sutures, and the area is dressed appropriately to protect the surgical site and promote healing.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing. Patients may be advised to keep the area clean and dry, and to follow specific instructions regarding activity restrictions to avoid strain on the healing finger. Follow-up appointments are typically scheduled to assess the recovery process and to remove sutures if necessary. Patients should be informed about potential complications, such as scarring or recurrence of constriction, and the importance of reporting any unusual symptoms during the recovery period.

Short Descr EXCISION CONSTRICTING TISSUE
Medium Descr EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
Long Descr Excision of constricting ring of finger, with multiple Z-plasties
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply 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 Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P3D - Major procedure, orthopedic - other
MUE 1
CCS Clinical Classification 175 - Other OR therapeutic procedures on skin and breast
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).
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.
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F7 Right hand, third digit
F9 Right hand, fifth digit
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2011-01-01 Changed Guideline information changed.
Pre-1990 Added Code added.
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