How To Use CPT Code 25628

CPT 25628 describes the open treatment of a carpal scaphoid (navicular) fracture, including internal fixation, when performed. 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 25628?

CPT 25628 can be used to describe the open treatment of a carpal scaphoid (navicular) fracture, which involves the use of internal fixation to stabilize the fracture. This code is used when a provider performs an incision in the wrist to access the fracture and applies wires or screws to secure the bones while healing takes place.

2. Official Description

The official description of CPT code 25628 is: ‘Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed.’

3. Procedure

1. The provider makes an incision over the fracture site in the wrist.
2. The provider reduces, or realigns, the fracture into the correct position.
3. Wires or screws are inserted to secure the bones in place.
4. The incision is closed.
5. A radiographic image is obtained to confirm adequate reduction of the fracture.
6. A splint or cast material is applied to prevent movement of the fracture until healing takes place.

4. Qualifying circumstances

Patients eligible to receive CPT 25628 services are those with a carpal scaphoid (navicular) fracture that requires open treatment with internal fixation. The provider must make an incision in the wrist to access the fracture and apply wires or screws to stabilize the bones. This procedure is typically performed when the fracture is severe or unstable and cannot be effectively treated with non-surgical methods.

5. When to use CPT code 25628

CPT code 25628 should be used when a provider performs open treatment of a carpal scaphoid (navicular) fracture and utilizes internal fixation to stabilize the bones. This code should only be used when the procedure is performed, and not for other types of treatment or management of the fracture.

6. Documentation requirements

To support a claim for CPT 25628, the provider must document the following information:

• Patient’s diagnosis of a carpal scaphoid (navicular) fracture
• Description of the procedure performed, including the use of internal fixation
• Date of the procedure
• Details of the incision made and the method of fracture reduction
• Type and placement of wires or screws used for internal fixation
• Confirmation of adequate reduction through radiographic images
• Type of splint or cast material applied

7. Billing guidelines

When billing for CPT 25628, ensure that the procedure meets the criteria for open treatment of a carpal scaphoid (navicular) fracture with internal fixation. Use additional codes to report any other services or supplies provided during the same encounter. Follow the appropriate coding guidelines and modifiers to accurately reflect the services rendered.

8. Historical information

CPT 25628 was added to the Current Procedural Terminology system on January 1, 1990. The code was later revised on January 1, 2008 to include the option of internal or external fixation for the treatment of carpal scaphoid (navicular) fractures.

9. Examples

1. A provider performs an open treatment of a carpal scaphoid (navicular) fracture in a patient who fell and injured their wrist.
2. A patient with a severe carpal scaphoid (navicular) fracture undergoes open treatment with internal fixation to stabilize the bones.
3. A provider performs an incision in the wrist and applies screws to secure the bones in a patient with a carpal scaphoid (navicular) fracture.
4. A carpal scaphoid (navicular) fracture is treated with open reduction and internal fixation in a patient involved in a motor vehicle accident.
5. A provider performs open treatment with internal fixation for a carpal scaphoid (navicular) fracture that occurred during a sports activity.
6. A patient with a carpal scaphoid (navicular) fracture undergoes open treatment with internal fixation to promote proper healing.
7. A provider performs an incision in the wrist and applies wires to stabilize the bones in a patient with a carpal scaphoid (navicular) fracture.
8. An open treatment with internal fixation is performed in a patient with a carpal scaphoid (navicular) fracture caused by a workplace injury.
9. A provider performs open reduction and internal fixation to treat a carpal scaphoid (navicular) fracture in a patient involved in a fall.
10. A patient with a carpal scaphoid (navicular) fracture undergoes open treatment with internal fixation to restore proper wrist function.