Orthopedic Coding Alert

Question: What exactly does "with or without internal or external fixation" mean when a CPT code's descriptor includes this statement? My physician thinks that he should be able to report an additional code for fixation.

Iowa Subscriber

Answer: The phrase "with or without internal or external fixation" means just that. A code descriptor containing this phrase has been valued so that the reimbursement involved covers all the physician work, including internal or external fixation if the physician performs fixation concurrently.

For example, 25515 (Open treatment of radial shaft fracture, with or without internal or external fixation) has 17.74 relative value units (RVUs) when your orthopedist performs the procedure in the operating room. The code's relative value covers the physician's work to reduce the fracture, close the wound and stabilize the bone using fixation of any type.

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.