Orthopedic Coding Alert

Question: I performed ulnar and radial nonunion repair with autograft through two separate incisions. I would like to report two units of 25405 (Repair of nonunion or malunion, radius OR ulna; with autograft [includes obtaining graft]) for this, but my coder believes we should bill one unit of 25420 (Repair of nonunion or malunion, radius AND ulna; with autograft [includes obtaining graft]) instead. Who is correct?

Mississippi Subscriber

Answer: The reimbursement for 25420 includes separate radial and ulnar incisions, so the physician is incorrect in his belief that he can recoup additional reimbursement for the additional incision. Therefore, you should report only one unit of 25420.

If you billed two units of 25405, your carrier would probably assume that you repaired a nonunion of the radius or ulna on the left arm and another on the right arm. If it later learned that you performed both repairs on the same arm, you would likely have to reimburse it for the additional payment.