August 2016 - NICE is updating this guidance (see the in development page for information). The NHS should continue to follow the recommendations in this guidance until the update is complete.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Radiation therapy for early Dupuytren's disease.


In Dupuytren’s disease, connective tissue in the hands (called the palmar fascia) becomes thickened and shortened (contracted). This causes ridges in the palm, and stiff fingers that bend towards the palm and cannot be straightened.

The aim of treatment is to soften the contracted tissue to allow the patient to regain use of their hand. Radiation therapy for early Dupuytren’s disease involves directing low energy X-rays at the affected tissue with the aim of stopping the disease becoming more widespread. Treatment can be repeated in some patients.

Coding recommendations

X65.4 Delivery of a fraction of external beam radiotherapy NEC

Y91.3 Superficial or orthovoltage treatment for radiotherapy

Z89.4 Hand NEC

In addition ICD-10 code M72.0 Palmar fascial fibromatosis [Dupuytren] is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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