Reader Questions: 25605 or 25606, but Not Both

Question: How should I report a closed reduction of a distal radius fracture with percutaneous fixation? The orthopedist thinks we should be coding both 25605 and 25606. Is this correct?

North Carolina Subscriber

Answer: The national Correct Coding Initiative (CCI) states that 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: APC 00043) is mutually exclusive with 25606 (Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation: APC 00062). This means that you cannot report these two codes together because they indicate two different means of treating the same condition. In fact, 25606 includes the work of manipulating the fracture to align the bones for percutaneous fixation.

Keep in mind: Although CCI bundles 25605 and 25606, it gives the edit a "1" modifier indicator, so you can break the edit under certain circumstances with a modifier, such as 59 (Distinct procedural service). But the only circumstance when you might report both of these codes on a single date of service for one patient would be if your orthopedist treats fractures of both wrists -- one with closed treatment with manipulation (25605) and one with percutaneous fixation (25606).

You would use modifier 59 and modifiers LT (Left side) and RT (Right side) to clarify which wrist received which type of treatment.