Orthopedic Coding Alert

Question: Last week, our surgeon reduced a patient's distal radius fracture and we charged code 25605. Today, she came back and we had to re-reduce it. Should I charge 25605 again with modifier 78, 58 or 76?


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Answer: Most coders recommend that you report 25605 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, with or without fracture of ulnar styloid; with manipulation) with modifier 76 (Repeat procedure by same physician) appended for this procedure.

Although some coders believe you should only append modifier 76 when the surgeon repeats the same procedure on the same date, you can actually use modifier 76 for a procedure that the surgeon repeats anytime during the postoperative period. 

You could also consider modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) for the surgery if the surgeon prefers it over modifier 76 in this case.

You shouldn't append modifier 78 (Return to the operating room for a related procedure during the postoperative period) because it signals a return to the OR and you most likely did not take the patient to the OR for a closed reduction.

Stave off denials: Be sure to use an appropriate ICD-9 code on the second reduction to indicate why the surgeon performed a second reduction on the same bone.