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Q&A: CPT coding for a closed treatment of a metacarpal fracture, with manipulation

JustCoding News: Inpatient, October 28, 2009

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QUESTION: What code(s) should we report for the following procedure: Closed reduction, percutaneous pinning of the left fifth metacarpal base fracture?

Once general endotracheal anesthesia was achieved, the left upper extremity was manipulated under fluoroscopy to show a mobile fracture that was reducible with traction and manual pressure.

A 0.045 K-wire was then placed on the direct ulnar aspect of the fifth metacarpal base. Fluoroscopy was used to confirm adequate positioning at the base of the fifth metacarpal. The K-wire was then advanced into the fracture fragment into the third and fourth metacarpal base. A second K-wire was then placed approximately 1 cm distal and parallel to the previous K-wire into the fifth and fourth metacarpal. Fluoroscopy was used to confirm adequate reduction of the fifth carpometacarpal joint space and proper placement of K-wire pins. The K-wires were then cut at the level of the skin and buried underneath the skin.

Is CPT code 26605 (Closed treatment of metacarpal fracture, single; with manipulation, each bone) the correct code for this case?

ANSWER: From the notes you provided, I would agree that it would be correct to report CPT code 26605 for this procedure. In addition, I would report CPT code 26608 (Percutaneous skeletal fixation of metacarpal fracture, each bone) because the physician performed percutaneous fixation as well.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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