Orthopedic Coding Alert
Define ''With or Without' In a CPT® Descriptor
Question: What exactly does “with or without internal or external fixation” mean when a CPT® code’s descriptor includes this statement? My physician thinks that he should be able to report an additional code for fixation.
Kentucky Subscriber
Answer: The phrase “with or without internal or external fixation” means just that. A code descriptor containing this phrase has been valued so that the reimbursement involved covers all the physician work, including internal or external fixation if the physician performs fixation concurrently.
In other words, “with or without internal or external fixation” refers to open treatment of fracture codes, indicating that the same code is used whether or not internal or external fixation has been used in the treatment. You cannot add additional codes for internal or external fixation when this statement is used in the code descriptor. This is true for almost all open treatment fracture codes except in the spine.
For example, 25515 (Open treatment of radial shaft fracture, with or without internal or external fixation) has 19.90 relative value units (RVUs) when your orthopedist performs the procedure in the operating room. The code’s relative value covers the physician’s work to reduce the fracture, close the wound and stabilize the bone using fixation of any type.
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