© Copyright 2025 American Medical Association. All rights reserved.
Dupuytren's contracture is a condition characterized by the thickening and tightening of the palmar fibrous tissue, which occurs due to an excessive deposition of collagen beneath the skin of the hand and fingers. This condition is typically painless; however, the resultant thickening leads to a flexion contracture, making it challenging or even impossible for the affected individual to fully extend one or more fingers. The procedure associated with CPT® Code 20527 involves the injection of an enzyme, such as collagenase, directly into the palmar fascial cord. This enzyme acts to weaken the fibrous cords that have formed, thereby facilitating the subsequent manipulation of the hand and fingers. The use of ultrasound may be employed to visualize the soft tissues of the hand, allowing for the precise identification of the flexor tendon. It is crucial to measure the depth from the skin to the surface of the flexor tendon to avoid accidental injection into the tendon itself, as the injection should be limited to the fibrous tissue cords. Following the injection, the patient is scheduled to return the next day for a separate procedure that involves the manipulation of the hand and mechanical breakage of the cord, which aims to straighten the fingers and restore functionality.
© Copyright 2025 Coding Ahead. All rights reserved.
Dupuytren's contracture is indicated for treatment when the thickening of the palmar fibrous tissue leads to a flexion contracture that significantly impairs the ability to extend the fingers. The procedure is typically considered when the contracture affects the functionality of the hand, making daily activities difficult for the patient.
The procedure begins with the identification of the affected area in the hand, where the Dupuytren's contracture has developed. Using ultrasound imaging, the soft tissues of the hand are visualized to accurately locate the fibrous cords that require treatment. This imaging is essential to ensure that the flexor tendon is not inadvertently injected, as the injection should be confined to the fibrous tissue. The depth from the skin to the surface of the flexor tendon is measured to confirm the correct injection site. Once the appropriate location is determined, a needle attached to a syringe containing the enzyme collagenase is carefully advanced into the fibrous tissue. The enzyme is then injected into the palmar fascial cord, where it works to weaken the fibrous tissue cords. This enzymatic action is crucial for the subsequent manipulation of the hand. After the injection, the patient is scheduled to return the following day for a separate procedure that involves the mechanical breakage of the cord and manipulation of the fingers, which aims to straighten the fingers and restore their range of motion.
After the injection of collagenase, the patient is expected to return the following day for a manipulation procedure. During this follow-up, the physician will perform mechanical breakage of the fibrous cord, which is essential for straightening the fingers affected by the contracture. Post-procedure care may include monitoring for any adverse reactions to the injection and ensuring that the patient follows any specific instructions provided by the healthcare provider regarding hand movements and activities. The expected recovery involves gradual improvement in the ability to extend the fingers, with the goal of restoring normal hand function.
| Short Descr | INJ DUPUYTREN CORD W/ENZYME | Medium Descr | INJECTION ENZYME PALMAR FASCIAL CORD | Long Descr | Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren's contracture) | Status Code | Active Code | Global Days | 000 - Endoscopic or 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) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 | CCS Clinical Classification | 156 - Injections and aspirations of muscles, tendons, bursa, joints and soft tissue |
| 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). | F8 | Right hand, fourth digit | 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. | 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 | F9 | Right hand, fifth digit | F4 | Left hand, fifth digit | 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. | 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. | 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.) | 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.) | 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 | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | FA | Left hand, thumb | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | JW | Drug amount discarded/not administered to any patient | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | T3 | Left foot, fourth digit | T4 | Left foot, fifth digit | 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 |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2012-01-01 | Added | Added |
Get instant expert-level medical coding assistance.