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A decompressive fasciotomy of the hand is a surgical procedure aimed at alleviating pressure within the osteofascial compartments of the hand, which can become critically elevated due to conditions such as compartment syndrome. Compartment syndrome may arise from various causes, including traumatic injuries like crushing incidents, thermal injuries such as burns, or inadvertent infiltration of intravenous medications into the soft tissues of the hand. The hand consists of ten distinct osteofascial compartments, each containing muscles, nerves, and blood vessels, which are encased in a fibrous sheath. When pressure builds up within these compartments, it can lead to severe complications, including muscle and nerve damage. To effectively relieve this pressure, the surgeon may utilize dorsal incisions over the second and fourth metacarpals, allowing access to the affected compartments. The procedure involves retracting the extensor tendons to expose both the dorsal and volar interosseous compartments. Each compartment is then opened through a longitudinal incision, facilitating the release of pressure. Following the fasciotomy, the surgical wounds are typically covered with a sterile dressing to manage any swelling. Once the tissue swelling has subsided, the wounds may be closed with sutures, or if necessary, separate skin grafting procedures may be performed to promote healing and restore the integrity of the hand's structure.
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The decompressive fasciotomy of the hand is indicated for the treatment of compartment syndrome, which can occur under various circumstances. The following conditions may necessitate this surgical intervention:
The procedure for performing a decompressive fasciotomy of the hand involves several critical steps to ensure effective release of pressure within the affected compartments:
Post-procedure care following a decompressive fasciotomy of the hand is essential for optimal recovery. Patients are typically monitored for signs of infection, excessive swelling, or complications related to the surgery. The surgical wounds are kept clean and dry, and the sterile dressings are changed as needed. Pain management is also an important aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Rehabilitation may be necessary to restore function and strength in the hand, and physical therapy may be recommended to aid in recovery. The timeline for recovery can vary based on the extent of the surgery and the individual patient's healing process.
| Short Descr | DECOMPRESS FINGERS/HAND | Medium Descr | DECOMPRESSIVE FASCIOTOMY HAND | Long Descr | Decompressive fasciotomy, hand (excludes 26035) | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; 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 | 160 - Other therapeutic procedures on muscles and tendons |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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). | 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. | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F2 | Left hand, third digit | F4 | Left hand, fifth digit | F9 | Right hand, fifth digit | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | 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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| 1990-01-01 | Added | First appearance in code book in 1990. |
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