Q&A: Limited open reduction without internal fixation
JustCoding News: Outpatient, November 30, 2011
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QUESTION: In the past, we reported CPT® code 25620 for open reduction of distal radius and ulna fracture with or without internal fixation. The AMA replaced that code with three other CPT codes, all of which include internal fixation:
We had a case where the physician performed a limited open reduction of a distal radius and ulna fracture without internal fixation after unsuccessful closed reduction in the ED. Which CPT code would you suggest we assign for this procedure?
ANSWER: First, let’s start by looking at the three new codes and their definitions. They are:
- 25607, open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation
- 25608, open treatment of distal radial intra?articular fracture or epiphyseal separation; with internal fixation of two fragments
- 25609, open treatment of distal radial intra?articular fracture or epiphyseal separation; with internal fixation of three or more fragments
We recommend that you append modifier -52 (reduced services) to the correct procedure code and include documentation explaining that internal fixation was not provided due to (whatever reasons the physician documented for not including the internal fixation).
Editor’s note: Shelley C. Safian, PhD, 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. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC-A, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.
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