Orthopedic Coding Alert

Question: A Medicare patient fractured her distal radius and ulna. Our orthopedist performed a closed reduction in the emergency room to relieve pressure on the median nerve. Later that day, the same surgeon completed an open reduction internal fixation in the operating room. Can we bill for both procedures?

New Hampshire Subscriber

Answer: Yes, this scenario involves two encounters and two procedures.

First encounter: Code 25605 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation) for the reduction. Include an E/M service code and modifier 57 (Decision for surgery).

Second encounter: Submit 25608 (Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments) for the surgical repair. Then append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) because it represents a more extensive, planned procedure performed during the original surgery's postoperative period.