# Open vs Closed Treatment HELP!!!!!!



## banderson77 (Oct 28, 2009)

One of my doctors is billing 25525 on a patient.  I am questioning his decision on choosing this code because there is NO mention of the radius or the ulna going through the skin.  I clearly remember from school that you only use the "open treatment" fracture codes if the bones are going through the skin.  Of course, others in my office are disagreeing with me by stating that "if the doctor cuts the skin open, that makes it an open treatment."  Can some one clarify this for me as if I didn't know the answer.


----------



## AuntJoyce (Oct 28, 2009)

*Open vs Closed*

Good morning!  I think you are confusing the open vs closed fracture with open vs closed treatment.  An open fracture is also called a compound fracture.  You can have a simple closed fracture that requires open treatment.  That is to say, if the fracture is of the radius and it is mal-positioned, although the fracture is a closed fracture, the surgeon needs to get inside to re-align the bones.  

Hope this helps!


----------



## mbort (Oct 28, 2009)

I agree, I think you are confusing the diagnosis codes with the procedure codes.

You will only use "open" fracture diagnosis codes for those fractures that have pierced through the skin which are then referred to as "open fractures"

Like the previous post, as soon as the doctor incises the skin, this then becomes an open procedure (not to be confused with arthroscopic, laparoscopy and/or hysteroscopic codes etc).

Hope this helps


----------



## banderson77 (Oct 28, 2009)

I may have mis-worded the question.  It has nothing to do with the diagnosis codes.  The question is which CPT code is better.  The patient had a fx of both bones, Galeazzi fracture with no mention of the fracture breaking the skin.  The doctor did an ORIF.  He wants to bill 25525 which states "open treatment of radial shaft facture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (Galeazzi fracture/dislocation), includes percutaneous skeletal fixation, when performed."  I think we should be billing a 25520 "Closed Treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint."  The bones are clearly misaligned and need the ORIF which the hardware was only placed on the radius not the ulna.


----------



## coderguy1939 (Oct 28, 2009)

The fracture does not need to be closed in order for the doctor to perform an open reduction and internal fixation repair.  If the doctor did an ORIF then an open code would be appropriate.


----------



## dmaec (Oct 28, 2009)

ORIF -- in itself tells you it IS OPEN - *O*pen *R*eduction and *I*nternal *F*ixation...

If your provider is doing an ORIF...they're not doing "closed" treatment of a closed fracture - they're doing Open treatment of what you say is a closed fracture.  

I have to agree with AuntJoyce and mbort - I think you might be confusing the Fracture "PRESENTATION" vs the Fracture "TREATMENT"..

btw- you can't do a closed ORIF -- ORIFs are Open... (by definition alone)


----------



## AuntJoyce (Oct 28, 2009)

*OPEN vs CLOSED*

This is such a common mis-interpretation.  In the scenario you are describing, the patient clearly had a closed fracture(s) of the radius and ulna.  However, in order to repair these fractures and to re-align them, the surgeon does need to get inside the arm to expose the bones.  Once the incision is made, the surgeon "opens" the extremity to expose these bones thereby making it an open repair.  Even if the fracture was compound (having exited the skin to the outside world), the repair would still be considered open.

If the fracture(s) was clean and well-aligned and required no re-alignment and even if the fracture was mal-aligned but could be placed back in alignment with just a closed manipulation (no incision required), then this would define your closed treatment of the fracture(s).

Good luck!


----------



## AuntJoyce (Oct 28, 2009)

*OPEN vs CLOSED*

Sorry - I meant to say that the appropriate code to consider then is 25575 if indeed both the radius and ulna are fractured.

Your scenario is indicative of OPEN treatment of a CLOSED fracture...don't let those descriptors fool you.  An open fracture is the diagnosis.  An open repair is the procedure.

Have a great day!


----------

