How To Use CPT Code 25405

CPT 25405 describes the repair of a nonunion or malunion deformity in either the radius or ulna bone of the lower arm using an autograft. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 25405?

CPT 25405 is used to describe the repair of a nonunion or malunion deformity in either the radius or ulna bone of the lower arm. The procedure involves cutting the undeveloped or improperly grown bone and fixing it with the help of a bone graft taken from the patient’s own body.

2. Official Description

The official description of CPT code 25405 is: ‘Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft)’. This code specifically refers to the repair of nonunion or malunion deformities in the radius or ulna bone using an autograft.

3. Procedure

1. The provider begins by making an incision over the radial or ulnar shaft and exposing the area of nonunion or malunion.
2. Using a cutting instrument, such as an electrical saw, the provider excises the irregular bony area.
3. A graft is then harvested from the patient’s own body, typically from the iliac bone or another long bone.
4. The harvested graft is used to bridge the gap created after the excision of the irregular bone ends.
5. The provider ensures proper alignment of the repaired site.
6. The operative site is irrigated and sutured, and a splint is placed to immobilize the arm.

4. Qualifying circumstances

CPT 25405 is performed on patients with nonunion or malunion deformities in the radius or ulna bone. Nonunion refers to the lack of bone union after a fracture, while malunion refers to incomplete or faulty union after a fracture. The procedure requires the use of an autograft, which is a graft taken from the patient’s own body.

5. When to use CPT code 25405

CPT code 25405 should be used when a provider performs a repair of a nonunion or malunion deformity in either the radius or ulna bone using an autograft. It is important to note that this code specifically includes the obtaining of the graft. If the repair is performed without a graft, a different code should be used.

6. Documentation requirements

To support a claim for CPT 25405, the provider must document the following information:

• Patient’s diagnosis of nonunion or malunion deformity
• Details of the procedure, including the use of an autograft
• Date of the procedure
• Start and end time of the procedure
• Confirmation of proper alignment of the repaired site
• Details of any additional procedures performed, if applicable
• Signature of the provider

7. Billing guidelines

When billing for CPT 25405, ensure that the procedure involves the repair of a nonunion or malunion deformity in either the radius or ulna bone using an autograft. It is important to note that the obtaining of the graft is included in this code. If the repair is performed without a graft, a different code should be used.

8. Historical information

CPT 25405 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2002, the description of the code was updated to specify the use of an iliac or other autograft for the repair.

9. Examples

1. A provider performs a repair of a nonunion deformity in the radius bone of a patient’s lower arm using an autograft.
2. A patient presents with a malunion deformity in the ulna bone of their lower arm, and a provider performs a repair using an autograft.
3. A provider treats a nonunion deformity in both the radius and ulna bones of a patient’s lower arm by performing a repair with autografts.
4. A patient with a malunion deformity in the radius bone undergoes a repair procedure using an autograft.
5. A provider performs a repair of a nonunion deformity in the ulna bone of a patient’s lower arm using an autograft.
6. A patient presents with a malunion deformity in both the radius and ulna bones, and a provider performs a repair using autografts.
7. A provider treats a nonunion deformity in the radius bone of a patient’s lower arm by performing a repair with an autograft.
8. A patient with a malunion deformity in the ulna bone undergoes a repair procedure using an autograft.
9. A provider performs a repair of a nonunion deformity in both the radius and ulna bones of a patient’s lower arm using autografts.
10. A patient presents with a malunion deformity in the radius bone, and a provider performs a repair using an autograft.