Orthopedic Coding Alert

Question: Operative findings included a healed fracture malunion with shortening of distal radius, positive ulnar variant, and a recurrent or new fracture over the radial and volar aspect of the distal radius. Our surgeon performed collective radial lengthening osteotomy of the left wrist and ORIF with allograft bone grafting (he packed cancellous bone chips into the defect). How should I code these procedures?

Washington Subscriber

Answer: The closest choice is 25391 (Osteoplasty, radius or ulna, lengthening with autograft). CPT does not include a code for malunion repair with only allograft, as you describe, because allografts are bundled with the primary procedure.

Explanation: Although 25391 represents an autograft and you're coding an allograft, 25391 is still your most accurate option. Consider appending modifier 52 (Reduced services) since your surgeon didn't complete an autograft, but verify the carrier's guidelines first.