How To Use CPT Code 25426

CPT 25426 describes the repair of a defect in the radius and ulna bones of the lower arm using autografts. 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 25426?

CPT 25426 is used to describe the repair of a defect in the radius and ulna bones of the lower arm using autografts. This code is used when the provider excises the problem bony areas and fixes them with bone grafts taken from the patient’s own body. The repair is performed to treat defects caused by injury, bone disease, or previous surgical procedures.

2. Official Description

The official description of CPT code 25426 is: ‘Repair of defect with autograft; radius AND ulna.’

3. Procedure

1. The provider makes an incision over the radial and ulnar shafts and exposes the areas of defect.
2. Using a cutting instrument, the provider excises the problem bony areas.
3. The provider harvests grafts from any long or flat bone of the patient’s body.
4. The grafts are used to bridge the gaps created after excision of the defects.
5. The provider confirms the repair of the sites.
6. The operative site is irrigated and sutured, and a splint is placed for the immobilization of the arm.

4. Qualifying circumstances

CPT 25426 is performed when there is a defect in both the radius and ulna bones of the lower arm that requires repair. The defect can be caused by injury, bone disease, or previous surgical procedures. The use of autografts, which are tissues or organs transplanted from one part to another of the same body, is a qualifying circumstance for this code.

5. When to use CPT code 25426

CPT code 25426 should be used when the provider performs a repair of a defect in both the radius and ulna bones of the lower arm using autografts. This code should not be used for repairs involving only the radius or ulna bones. It is important to accurately document the use of autografts and the specific bones from which they are harvested.

6. Documentation requirements

To support a claim for CPT 25426, the provider must document the following information:

• Patient’s diagnosis and the presence of a defect in both the radius and ulna bones
• Details of the procedure, including the incision, excision of bony areas, and use of autografts
• Date of the procedure
• Confirmation of repair of the defect
• Operative site irrigation, suturing, and placement of a splint
• Signature of the provider

7. Billing guidelines

When billing for CPT 25426, ensure that the procedure involves the repair of a defect in both the radius and ulna bones using autografts. It is important to accurately document the use of autografts and the specific bones from which they are harvested. There are no specific guidelines regarding reporting CPT 25426 with other codes.

8. Historical information

CPT 25426 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performing a repair of a defect in the radius and ulna bones of the lower arm using autografts after a traumatic injury.
2. A surgeon excising problem bony areas and fixing them with autografts to repair a defect in the radius and ulna bones caused by bone disease.
3. A provider performing a revision surgery to repair a defect in the radius and ulna bones using autografts after a previous surgical procedure.
4. A surgeon repairing a defect in the radius and ulna bones using autografts to correct a congenital bone deformity.
5. A provider performing a repair of a defect in the radius and ulna bones using autografts to treat a nonunion fracture.
6. A surgeon excising problem bony areas and fixing them with autografts to repair a defect in the radius and ulna bones caused by bone infection.
7. A provider performing a revision surgery to repair a defect in the radius and ulna bones using autografts after a failed previous repair.
8. A surgeon repairing a defect in the radius and ulna bones using autografts to correct a bone deformity caused by a tumor.
9. A provider performing a repair of a defect in the radius and ulna bones using autografts to treat a bone cyst.
10. A surgeon excising problem bony areas and fixing them with autografts to repair a defect in the radius and ulna bones caused by avascular necrosis.