Orthopedic Coding Alert

Question: The orthopedic surgeon treats a patient with a right-sided radial and ulnar fracture with angulation. Both fractures are nondisplaced; the radial fracture is in the neck of the radius, and the ulnar fracture is a transverse fracture on the shaft. The skin is intact, and the surgeon performs manipulation of the fracture without performing an incision. This restores the bones to normal alignment, and the surgeon splints the patient’s forearm to immobilize the fracture. Can I report two surgical codes for the fixes?

Rhode Island Subscriber

Answer: No, you cannot report two surgical codes for this encounter. On the claim, you’ll report 25565 (Closed treatment of radial and ulnar shaft fractures; with manipulation) for the treatment. Remember to append S52.134A (Nondisplaced fracture of neck of right radius, initial encounter for closed fracture) and S52.224A (Nondisplaced transverse fracture of shaft of right ulna, initial encounter for closed fracture) to 25565 to represent the patient’s radial and ulnar fractures. Also, append modifier RT (Right side) to 25565 to indicate laterality.

Explanation: Since there is a combination code for treatment of these fractures, you must report that code. If the surgeon only treated the fracture of the radius, you’d report 25505 (Closed treatment of radial shaft fracture; with manipulation); if the surgeon only treated the fracture of the ulna, you’d report 25535 (Closed treatment of ulnar shaft fracture; with manipulation).

Chris Boucher, MS, CPC, Senior Development Editor, AAPC