By Mandeara Frye, RHIA, CPC, CPMA, CRC, CASCC, Senior Director, Coding
Distal radius fracture treatment coding seems fairly straightforward to
most, but with payers cracking down on documentation requirements, it’s
worth reviewing the code options and requirements. There are several types
of distal radius fractures (e.g., Barton’s, Colles’, Salter-Harris).
For this column, we are focusing on two major distinctions: extraarticular
versus intraarticular. First, here are key terms to understand when coding
these procedures.
Fracture Definitions
Extraarticular: a fracture that does not enter the joint (extra = outside,
articular = joint)
Intraarticular: a fracture line that extends into the joint (intra = inside)
Closed fracture: the skin remains intact; also known as a simple fracture
Open fracture: the broken bone protrudes through the skin; also known as
a compound fracture
Comminuted fracture: a bone that is broken into three or more pieces (i.e.,
fragments)
Closed treatment: the fracture is reduced and/or manipulated without needing
an open incision or internal hardware/fixation
Percutaneous treatment: the fracture is treated by placing wires and/or
screws without an open incision
Open treatment: the fracture treatment requires an open incision to reduce
the fracture and place hardware (internal fixation)
Extraarticular Fracture Coding
CPT selection for extraarticular fractures should be based on the type
of fracture treatment required (closed, percutaneous, or open).
- 25605 — Closed treatment of distal radial fracture (e.g., Colles
or Smith type) or epiphyseal separation, includes closed treatment of
fracture of ulnar styloid, when performed; with manipulation
- 25606 — Percutaneous skeletal fixation of distal radial fracture
or epiphyseal separation
- 25607 — Open treatment of distal radial extra-articular fracture
or epiphyseal separation, with internal fixation
Intraarticular Fracture Coding
CPT selection should still be based on the type of fracture treatment required
(closed, percutaneous, or open), but there is an added element for open
fracture treatment: the number of fragments that receive internal fixation.
In addition to CPT 25605 for closed treatment and CPT 25606 for percutaneous
treatment, intraarticular fractures may also be coded with the following codes:
-
25608 — Open treatment of distal radial intra-articular fracture
or epiphyseal separation; with internal fixation of
2 fragments
-
25609 — Open treatment of distal radial intra-articular fracture
or epiphyseal separation; with internal fixation of
3 or more fragments
It’s important for the documentation to specify the number of fracture
fragments that are being fixated. It is not sufficient for the surgeon
to simply state there were three fragments in the diagnosis field. The
details of the procedure performed must include the specifics of what
is being done. If this information is not included, the coder will need
to query the physician for confirmation.
It’s also worth noting that the type of fracture (open or closed)
does not drive the method of treatment (open or closed). Closed fractures
are often treated with open reduction of the fracture and open fractures
may be treated using closed techniques on the bone. It’s important
for the coder to understand the anatomy, techniques, and correct coding pathways.
CPT Copyright 2023 American Medical Association. All rights reserved.
CPT® is a registered trademark of the American Medical Association.