# Distal Radius & Distal Ulnar Fracture



## gsteeves (Apr 2, 2010)

Good Morning,

Need help, please coding the following. Physician performed an ORIF distal ulna fracture and CRPP distal radius.  We do not do much fracture work at our ASC; my thoughts are 25606 for CRPP and 25545 for ORIF, just need some confirmation.

Thanks for your help and Happy Easter;

Gail Steeves, CPC


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## BCrandall (Apr 2, 2010)

25606 is fine for the radius, but if the ulnar fx was distal then 25545 won't work since that's for a shaft fracture. If you can post the op note that might help.


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## gsteeves (Apr 2, 2010)

Thanks, Bruce, I appreciate your help

The patient was taken to the operating room, placed in the supine position on the operating room table. General anesthesia was administered without complication. The left upper extremity was prepped and draped in the usual sterile manner. 

First a closed reduction of the ulnar was attempted. This was unsuccessful so I thus made an ulnar skin incision over the fracture site. It was taken down through the skin and subcutaneous tissue and exposed the ulnar fracture. I was then able to essentially rebreak the ulnar bone and put it in better alignment. Fluoroscopy was brought back in. I checked the alignment of the ulna and felt it to be acceptable. The alignment of the radius was not acceptable. I thus applied some force in a reduction maneuver and essentially rebroke the distal radius and placed in good alignment. This corrected the overall alignment of the forearm very nicely. To stabilize the ulna which is a small bone I placed a small 2.4 locking Synthes plate along the distal ulna. Three screws were placed proximal and distal to the fracture. The position of the screws and the hardware was checked and felt to be acceptable. 

Next a pinning of the distal radius was performed. First a 0.062 K-wire was placed from just proximal to the growth plate across the fracture site into the distal cortex. An additional 0.045 pin was placed for some extra support. These pins were cut off outside the skin. Final fluoroscopic images were taken. The wound was washed out. The skin was closed with Monocryl, Adaptic, 4x4's and a sugar tong splint. 

Gail Steeves, CPC


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## BCrandall (Apr 2, 2010)

Gail,

Going with the note, I'd use 25606, 25607, 25608 or 25609 depending on whether the fracture is extra or intra-articular. Check with your doctor on that. You could sure use a more comprehensive op note for sure!

Hope that helps!
-Bruce


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## gsteeves (Apr 2, 2010)

Thanks, I will contact the doctor's office to speak to the physician.  I appreciate your help with this.

Thanks,
Gail Steeves, CPC


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## BCrandall (Apr 2, 2010)

Glad to help!


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