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Insurance & Billing

 

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.

 


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