Dupuytren's Contracture is a relatively common problem and does not
require advanced testing for diagnosis or treatment. Whether your
treatment is a traditional open procedure, application of an external
fixator, or percutaneous release these treatments are not considered
experimental and are covered by Medicare and most other
insurances. Percutaneous Fasciotomy however is not
offered in most locations and some insurance companies may not be
familiar with this treatment. In order to avoid delays or denial for your care, you will need to contact your insurance
company to ensure they will authorize and pay for your procedure.
Your insurance company will need the following codes to provide authorization for your procedure.
ICD-9 Code
|
ICD-9 Description
|
CPT Code
|
CPT Description |
| 728.6 |
Dupuytren's Contracture
|
26040 |
Percutaneous Fasciotomy - one finger
|
| 728.79 |
Knuckle Pads
|
20550 |
Steroid Injection Dupuytren's Nodule
|
| 715.14 |
PIP joint arthritis
|
20600 |
Steroide Injecion of finger joint
|
| 736.21 |
Boutonniere Deformity
|
26060 |
Tendon release for boutonniere deformity
|
Click here for print version to send to your insurance company (it is an interactive PDF form, you can type in the appropriate information, print, sign, and mail OR simply print it out and fill out by hand.
Sometimes the authorization process is not as simple as it should be. Your insurance company is in the business of making money not providing medical care, so there are many obstacles they may put in your way to deny coverage of a procedure. In discussion of this issue with my colleagues who perform Percutaneous treatment throughout the country, here are some of the common reasons your insurance company may try to deny authorization.
| Reasons Given for Denial
|
What you need to Know
|
Dr. Grabow is not a provider on your insurance
|
Dr.Grabow is a Medicare provider as well as with many other insurance plans. Click here for a current list. If he is not a contracted provider for your insurance, we will provide you the necessary documentation to submit to your insurance plan for later reimbursement.
|
Other hand surgeons treat Dupuytren's Contracture.
|
While this is true, if you want percutaneous treatment for your Dupuytren's most hand surgeons do not offer this procedure. Ask your insurer for a list of providers that do perform percutaneous treatment. Make sure your provide them a copy of the cost comparison information. In general the total aggregate cost of traditional outpatient Dupuytren's surgery (which includes facility fee, anesthesia, surgeon, and therapy) is approximately ten to twenty times the cost of office based needle aponeurotomy.
|
This is cosmetic surgery and is not covered
|
If your insurance company tries to use this as a reason for denial this is fraud!
There is extensive scientific literature to support the functional benefits of dupuytren's contracture treatment (all types of treatment, NOT just percutaneous treatment). Correction of
contracture has been reported to improve hand function and dexterity
lost to the disease. Advanced untreated Dupuytren's
contracture has led to finger amputation for some patients, and
Dupuytren's alone has qualified some sufferers for permanent complete
medical disability.
If your insurance company persists in their denial, speak to a supervisor. If they still deny your treatment, get the supervisor's name and let them know you will be writing your state insurance commissioner to report your insurers fraudulent denial of a medically necessary treatment.
|