Cheryl Posted Thu 23rd of April, 2020 11:49:28 AM
The doctor took the patient to the OR for closed reduction with manipulation of an open radius/ulna distal fracture. He then explored the open fracture site and irrigated it and closed with sutures and then applied a cast. I am thinking code 25605 for the closed reduction but what about the irrigation and closure? .He really didn't debride the wound. Just washed it and closed it. Which code(s) would best describe? Thank you
SuperCoder Answered Fri 24th of April, 2020 03:20:44 AM
When there is an open fracture, so provider can treat it with open procedure. CPT 25607 can be used for open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation. In this procedure, the provider manipulates the bone into the correct position. He may use intramedullary nail for fixation and may also place interlocking screws at angles to the nail or wires across the fracture site to further stabilize the fracture. Once the fracture is stabilized, the provider controls any bleeding and closes the wound.
Since, the complete procedure not being performed as per CPT 25607, so you can append the modifier 52 (Reduced Services) with the procedure. Modifier 52 shows that the physician did not performed the complete procedure in the code descriptor.
Whereas, in CPT 25605, the provider treats a fracture of the wrist end of the radius, one of the bones in the forearm, in which the fracture fragment displaces upward or downward, in a closed procedure. The growth plate at the end of the bone may be displaced or the ulnar styloid, the bony bump on the ulna, fractured. He manipulates the fracture to realign the bony structures. He does not make an incision or open it. So, CPT 25605 would not be appropriate to bill for an open fracture.
Also, there may be discrepancy when open fracture ICD-10-CM code will not match with the closed reduction procedure.
Hope this helps!