Orthopedic Coding Alert

Question: One of our physicians did an “open reduction and percutaneous pinning of the right distal radius” on a 13-year-old who had a closed reduction done 11 days earlier. Our physician used a 1-cm incision. Should I report 25606 or 25607 for the following report?

The subcutaneous tissues down to the fracture site were dissected with blunt scissor dissection. A Freer elevator was then used to free up the early fracture callus and mobilize the distal radius fragment. It could then be reduced anatomically. As soon as I would release dorsal finger pressure on the fracture, it would want to translate posteriorly again.

It was felt that it was an unstable fracture and required percutaneous pinning. With the fracture anatomically reduced, a K wire was placed under fluoroscopic guidance.

California Subscriber

Answer: Because the surgeon documents both open treatment and percutaneous pinning, you should report 25607 (Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation). If the surgeon also performed the previous closed reduction, then you should append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period).

Correct Coding Initiative edits bundle 25606 (Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation) into 25607.

Watch for: Code 25607 refers to an extra-articular fracture, but 25608-25609 (Open treatment of distal radial intra-articular fracture or epiphyseal separation ...) describe intra-articular fractures.

Most distal radial fractures requiring surgery are intra-articular in adults. But children’s distal radius fractures tend to be extra-articular. If the surgeon doesn’t specify intra- or extra-articular fracture, have him amend the documentation so you can choose the right code.