CPT® Code 26121

Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)

The procedure described by CPT® Code 26121 refers to a fasciectomy performed specifically on the palm of the hand. This surgical intervention is indicated for the excision of thickened fascia, which may occur in the palm alone or extend to the fingers. The primary goal of this procedure is to relieve flexion contractures that can impede finger movement and functionality. During the operation, a zigzag incision is typically made over the palm and, if necessary, the affected fingers. This incision allows for the careful elevation of the skin and subcutaneous tissue, exposing the palmar fascia and the pretentious fascial cord beneath. Surgeons meticulously dissect the soft tissue at the metacarpal head, ensuring that the digital nerves and arteries adjacent to the tendon cords are identified and preserved throughout the procedure. The thickened fascia is progressively elevated from the proximal palm to the metacarpal head, and once fully detached from the surrounding nerves and vessels, it is excised. This excision effectively frees the underlying tendon, alleviating the flexion contracture of the affected finger. Following the removal of the thickened fascia, the soft tissues in the palm are rearranged as necessary to cover and protect the underlying structures. The surgical site is then closed, either by suturing the zigzag incision or by utilizing a skin graft if required. It is important to note that if the incision extends over the proximal interphalangeal joint and involves the removal of the fascial cord from a single finger, CPT® Code 26123 should be used. Additionally, for each additional finger from which the fascial cord is excised, CPT® Code 26125 is applicable.