Orthopedic Coding Alert

Question: We recently treated a radial fracture (25600). A few days later, the patient returned for a checkup and the orthopedist took an x-ray that showed a slight dorsal tilt on the fracture. The orthopedist gently manipulated the fracture as he applied a new cast. Can we bill 25605 for the second treatment?

Florida Subscriber

Answer: You should ask the orthopedic surgeon for clarification. If she applied manual force to achieve alignment of the fracture, you can 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) for the second treatment. Be sure to append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to 25605 to indicate that the subsequent fracture treatment was more extensive than the original procedure.

If, however, her service does not meet the definition of manipulation, you should simply report a casting code, such as 29065 (Application, cast; shoulder to hand [long arm]).