Orthopedic Coding Alert

Question: The physician performed a closed reduction of a fracture of both bones and a percutaneous pinning of a supracondylar fracture (same arm). He had to reduce the bottom bone fracture and apply the cast while he fixed the elbow. After he finished pinning the elbow, he removed the cast and then re-reduced the fracture of both bones. What CPT codes and modifiers should I use to describe these multiple procedures?

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Answer: Assuming that you are talking about fractures of both bones of the forearm and that your physician had to re-reduce the forearm fracture due to loss of reduction, the code for closed reduction of the radial and ulnar shafts is 25565 (closed treatment of radial and ulnar shaft fractures; with manipulation) Percutaneous pinning of a supracondylar fracture of the humerus is reported with 24538 (percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension). List the procedure with the higher relative value first and then append modifier -59 (distinct procedural service) to the lesser-valued procedure.  For the repeat closed reduction of the both bones forearm fracture, report 25565 again with modifier -76 (repeat procedure by same physician).