# Intramedullary nail radial shaft fracture



## fltbaroque (Nov 2, 2018)

Need help please! Patient presented with both bone shaft fracture radius and ulna. The doctor states in his note:
"I placed a small flexible intramedullary nail in her radius. I did not have to open this."
He also states in procedure description: 
"I initially made a small incision just proximal to the growth plate of the distal radius. I used a drill and a small awl to make a starting point was able to advance a small Synthes flexible rod down the shaft, across the fracture into the proximal radius. This provided excellent stability to the forearm."
There was nothing done to the ulna. 
So, there's no IM nailing or percutaneous code for the shaft of the radius.  Would you use an ORIF code with 52 modifier?

Thank you!!

Tobi C.


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## MI_CODER (Nov 2, 2018)

I would suggest using CPT 25574.

Per the 2018 CPT book (pg 108), "Open treatment is used when the fractured bone is either: 1) surgically opened (exposed to the external environment) and the fracture (bone ends) visualized and internal fixation may be used; *or 2) the fractured bone is opened remote from the fracture site in order to insert an intramedullary nail across the fracture site (the fracture site is not opened and visualized).*"

Also, you have stated the patient presented with a both bone fracture, however, only the radius was corrected. Per the Coder's Desk Reference, the CPT lay description for CPT 25574 states, "When both the radius and ulna are fractured, the physician exposes and reduces both fractures prior to fixation. Separate incisions along the forearm may be needed to expose the fracture. *In 25574, only one fracture is stabilized, requiring only one incision. The other fracture is stable and does not require fixation.*"


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## fltbaroque (Nov 5, 2018)

Set_Apart said:


> I would suggest using CPT 25574.
> 
> Per the 2018 CPT book (pg 108), "Open treatment is used when the fractured bone is either: 1) surgically opened (exposed to the external environment) and the fracture (bone ends) visualized and internal fixation may be used; *or 2) the fractured bone is opened remote from the fracture site in order to insert an intramedullary nail across the fracture site (the fracture site is not opened and visualized).*"
> 
> Also, you have stated the patient presented with a both bone fracture, however, only the radius was corrected. Per the Coder's Desk Reference, the CPT lay description for CPT 25574 states, "When both the radius and ulna are fractured, the physician exposes and reduces both fractures prior to fixation. Separate incisions along the forearm may be needed to expose the fracture. *In 25574, only one fracture is stabilized, requiring only one incision. The other fracture is stable and does not require fixation.*"



Thanks so much!


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