Orthopedic Coding Alert

Question: How should I code for the application of a uniplanar external fixator for a comminuted, intra-articular distal radius fracture in which a supplemental K-wire fixation was also used? In addition, an open bone grafting was performed through a separate incision with autologous cancellous bone from a bone bank.

I am leaning toward 25611 (percutaneous skeletal fixation of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, with or without fracture of ulnar styloid, requiring manipulation, with or without external fixation) but am not sure which bone grafting code to use.

Pennsylvania Subscriber

Answer: Code the open repair, 25620 (open treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, with or without fracture of ulnar styloid, with or without internal or external fixation). According to the American Academy of Orthopedic Surgeons, the graft is billable only if obtained as an autograft through a separate incision.

The percutaneous fixation would be considered part of the initial external fixation device, and not separately billable. If the procedure was extremely complicated, and the documentation supports the increased difficulty, consider appending modifier -22 (unusual procedural services), submitting the documentation and requesting additional payment. Success with this request will be contingent on the situation itself, the quality of the documentation, and carrier policy.