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ICD-10 Coding for Dupuytren’s Contracture

December 13, 2020

It can be challenging to locate and confirm the correct ICD-10 code for Dupuytren’s contracture because you cannot find it by looking directly for Dupuytren’s in the index of the ICD-10-CM codebook.

Furthermore, once you locate the correct code, the description does not say ‘Dupuytren’s contracture,’ which can be confusing, even for a medical coder.

The ICD 10 code for Dupuytren's contracture is M72.0-Palmar fascial fibromatosis [Dupuytren].

You find this code by referencing the ICD-10-CM index for‘Contraction(s), contracture, contracted,’ underneath that, find‘Dupuytren’s.’

 

Verifying M72.0 in the Tabular List

M72.0 falls in Chapter 13 of the ICD-10-CM tabular list, Diseases of the Musculoskeletal System and Connective Tissue (M00-M99). And it falls into block M70-M79 Other soft tissue disorders.

When referencing Category M72-Fibroblastic disorders, you’ll notice a red note letting the user know that this category’s codes require a fourth character.

You’ll also see an Excludes 2 note stating that retroperitoneal fibromatosis (D48.3) is not coded in this category. However, a patient may have both retroperitoneal fibromatosis and a condition from this category.

As you move down to M72.0-Palmar fascial fibromatosis [Dupuytren], you’ll see several notes.

The first and easiest note to miss is the letter A in a small orange box. This symbol means that M72.0 is an adult code, and you should only assign it to patients at least 15 years of age up to 124 years old.

The second note is under code M72.0, and it is the definition of Dupuytren’s contracture. The ICD-10 book defines Dupuytren’s Contracture as a flexion deformity of a finger, due to shortened, thickened fibrosing of palmar fascia.

The book goes on to say that the cause of Dupuytren’s contracture is unknown, but it is associated with long-standing epilepsy.

After checking all notes and symbols surrounding the category and code in the tabular list and following any instructions, you have successfully verified the ICD-10 code for Dupuytren’s contracture: M72.0-Palmar fascial fibromatosis [Dupuytren].

 

Clinical Presentation of Dupuytren’s Contracture

Dupuytren’s contracture is a condition that most commonly affects men who are older and of Northern European descent. It’s a deformity of the hand that typically develops over a long period of time.

The deformity affects the layer of tissue underneath the palm of the hand. Knots form in this layer of tissue until there are so many that they’ve formed a thick cord. This cord pulls or contracts at least one finger, leaving it stuck in a bent position.

Dupuytren’s contracture primarily affects the two fingers the furthest distance away from the thumb. The fingers stuck in a bent position cannot be completely straightened, complicating everyday tasks, such as holding commonplace objects, sometimes getting dressed independently, or even shaking hands.

 

Onset Signs ; Symptoms

Dupuytren’s contracture usually has a prolonged onset; it progresses over a number of years.

It typically begins with the skin of the palm becoming thicker with time. As the condition advances, the skin may start to dimple or pucker. Once far enough along, the tissue underneath the palm forms a firm lump that isn’t painful for most people but may be sensitive. These symptoms represent the beginning stages of Dupuytren’s contracture.

In more advanced stages of Dupuytren’s, the evident and debilitating deformity begins to develop. Under the palms, knots of tissue meld together, forming cords under the skin that may start extending their way towards the patient’s fingers.

Once the cords reach the patient’s fingers and begin tightening, one or more fingers may start being pulled towards the palm, in some cases, severely.

 

Clinical Diagnosis

Doctors are usually able to diagnose Dupuytren’s contracture by examining the patient’s hands. Further testing is not typically necessary to assign a clinical diagnosis of Dupuytren’s.

A doctor typically compares the hands during a physical exam and looks for puckering or dimpling on the palms. They will also palpate the patient’s hands and fingers, checking for lumps, knots, or cords of tissue.

There is one simple, telltale test doctors often have their patients perform. The doctor may ask the patient to try to lay their hand flat, palm-down, on the exam table or another surface in the exam room. If the patient cannot flatten their fingers completely, that is a good indicator of Dupuytren’s contracture.

 

Only Code Confirmed Cases

When assigning ICD-10 codes, it’s important only to code confirmed cases of Dupuytren’s contracture. You do not need positive results from a diagnostic test to assign code M72.0. A physician’s diagnostic statement of Dupuytren’s contracture in the medical record is sufficient to assign the ICD-10 code as a confirmed case.

ICD-10-CM Guideline II.H.-Uncertain Diagnosis, states that in the outpatient setting (i.e., a visit to the doctor’s office, urgent care, the emergency room, etc.), there are specific ways a doctor might word their diagnostic statement of Dupuytren’s contracture that you cannot code as a confirmed case.

Examples of diagnostic statements in clinical documentation that you cannot code as a confirmed case of Dupuytren’s contracture:

  • “Symptomsconsistent with Dupuytren’s contracture.”
  • “Marked hand deformity. Dupuytren’s contractureprobable.”
  • “Sensitive masses forming under palms. Dupuytren’s contracturelikely.”
  • “Palm skin thicker since last visit. Dupuytren’squestionable.”
  • “Palm band present on exam extending to left fifth digit. Patient can still flatten his hand completely. Dupuytren’s contracturepossible.”
  • Differential diagnosis includes Dupuytren’s contracture.”
  • Rule out Dupuytren’s contracture.”

Some of these statements are clinically diagnostic and are sufficient for a doctor to begin a patient’s treatment for Dupuytren’s contracture. However, according to ICD-10-CM coding guidelines, all of these statements are non-diagnostic. You cannot code Dupuytren’s contracture from any of the above documentation examples in the outpatient setting.

The inpatient setting and psychiatric hospitals have slightly different rules. However, Dupuytren’s diagnosis typically happens on an outpatient basis, so those rules don’t apply and aren’t relevant here.

 

Coding Signs ; Symptoms

ICD-10-CM Guideline I.B.4.-Signs and symptoms, states that you should code the patient’s signs and symptoms if the physician’s documentation does not include a definitive diagnosis.

The physician’s documentation may lack a definitive diagnosis because they used a clinically diagnostic statement (like one of the above examples) that you cannot use for coding purposes.

It’s also possible that the physician did not have enough information about the patient’s condition to diagnose the patient. They may send the patient for further testing or wait and observe the condition over time before making a diagnosis.

Let’s code the main signs and symptoms of Dupuytren’s contracture. First, look up the codes in the index of your codebook. Then, verify them in the tabular list.

Codes that are followed by a dash and a checkmark in the index are incomplete codes. Those symbols are there to tell you that you absolutely must verify those codes in the tabular list to get the additional characters and complete the code.

  • Skin thickening of the palm

Thickening > skin > R23.4

 

R23.4-Changes in skin texture

  • Skin dimpling and puckering of the palmChange > skin > specified change NEC > R23.8R23.8-Other skin changes
  • Lumps under the skin of the palmMass > localized (skin) > limb > upper > R22.3-When verifying this code in the tabular list, note the symbol that tells you this code needs a fifth character.R22.31-Localized swelling, mass and lump, right upper limbR22.32-Localized swelling, mass and lump, left upper limb
  • Sensitivity of the palmChange > sensory > R20.8R20.8-Other disturbances of skin sensation
  • Pain of the palmPain > limb > upper > hand > M79.64-When verifying this code in the tabular list, note the symbol that tells you this code needs a sixth character.M79.641-Pain in right handM79.642-Pain in left hand
  • Cords under the skin of the palmDisease > skin > L98.9L98.9-Disorder of the skin and subcutaneous tissue, unspecified
  • Contracture of the fingersContraction(s), contracture, contracted > joint > hand joint > M24.54-When verifying this code in the tabular list, note the symbol that tells you this code needs a sixth character.M24.541-Contracture, right handM24.542-Contracture, left hand
  • Hand deformityDeformity > limb > hand > M21.94-When verifying this code in the tabular list, note the symbol that tells you this code needs a sixth character.M21.941-Unspecified acquired deformity of hand, right handM21.942-Unspecified acquired deformity of hand, left hand

 

Code One or the Other

ICD-10-CM Guideline I.B.5. states that if the physician’s documentation meets the criteria for a definitive diagnosis, you should code Dupuytren’s contracture, but none of the patient’s symptoms of Dupuytren’s.

The basis of this guideline is that if you code a definitive diagnosis, we expect that the patient is experiencing the signs and symptoms of that condition. There is no need to code them in addition to the principal diagnosis.

However, ICD-10-CM Guideline I.B.6. states that if the patient is experiencing symptoms that are not an integral part of the disease process, then you should code those symptoms in addition to Dupuytren’s contracture.

 

Coding for Dupuytren’s Contracture

Diagnosis coding for Dupuytren’s contracture is tricky. However, if you follow ICD-10-CM guidelines carefully and mind all notes and symbols in your codebook, coding is much simpler.


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