orif distal radius cpt

ORIF Distal Radius CPT Codes (2022) – Descriptions, Guidelines, Reimbursement, Modifiers & Examples

ORIF Distal Radius CPT is an abbreviation for Open Reduction Internal Fixation. A distal radius ORIF is an outpatient procedure that takes approximately 30 to 90 minutes, and the physician usually does it under general or regional “nerve block” anaesthesia.

ORIF Distal Radius CPT Description

After the anesthesia, when the patient is relaxed and sleeping, the physician carries the ORIF distal radius CPT process out as follows:

First, by incision on the wrist and forearm (palm side).

By using surgical tools to evaluate the wrist and inspect the fracture.

By repairing the fracture and using a Plate with several Screws to fix the fracture location.

Then, the surgeons shut the wound using stitches and a plastic surgical procedure to minimize scarring.

Usually, treat mildly displaced fractures and non-displaced fractures non-surgically. However, it requires a plaster or collar for approximately 4 – 6 weeks till the bone recovers. Constantly monitor these with x-rays for the first 2 – 3 weeks to ensure that the fracture does not dislodge.

Displaced wrist fractures frequently require open surgery. Hard casts are rarely needed, which allows for improved fracture alignment and early wrist mobility. However, as the wrist is the basis of the hand, incorrect alignment of wrist fractures can result in ongoing discomfort, arthritis, finger stiffness, and reduced hand function.

Open surgery is a standard treatment option for wrist fractures that have no chance of getting repaired non-operatively. Many wrist fractures occur towards the end of the forearm bone, known as the radius and distal radius fractures.

Distal radius fractures exist in various patterns and types and treat these differently. A physician can repair them by restricting the movements to allow healing of the wrist in a cast or splint or by conducting an operation known as “open reduction internal fixation” (ORIF).

There are various surgical procedures for repairing distal radius fractures. Still, the most common type is an open incision with plate and screw fixation.

Through an incision, the provider surgically fixes a fracture of the lower radius, the bigger of the two lower arm bones far beyond the joint, or a separation of the radius and secures two radial bone parts with internal screws, wires, or pins.

The following are ORIF distal radius CPT codes for interventional and open distal radial fracture treatments that explain the various levels of complexity:

CPT 25606 describes percutaneous skeletal fixation of a distal radial fracture or epiphyseal separation.

cpt code distal radius orif

CPT 25607 describes the open treatment of distal radial extra-articular fracture or epiphyseal separation with internal fixation.

cpt code for orif distal radius

CPT 25608 describes the open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of two fragments.

cpt orif distal radius

CPT 25609 describes the open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation and including three or more fragments.

cpt code for orif distal radius fracture

ORIF Distal Radius CPT Guidelines & Reimbursement

ORIF distal radius CPT fractures can get complicated because of new technology (e.g., fracture specific fixation, fixed-angle plate fixation), and the recognition of distal radial fractures requires accurate repair. In recent years, the open treatment of a distal radial fracture has become very complicated.

The several distal radial fractures are displaced or non-displaced, Simple or complex (two parts, three parts, and four parts), and comminuted (with or without sigmoid notch involvement).

Accomplish open treatment of these fractures with plates, screws, pins, Kirschner wires, intramedullary rods, or combinations of Plates, Screws, Pins, and Wires. It is essential to get open surgery by a single incision (dorsal or palmar) or multiple (dorsal or palmar).

For accurate code assignment, the operative report should include the following when performed:

  • Intra-articularly (CPT 25608) or extra-articularly (CPT 25607) repair,
  • Necessitation of internal fixation with two (CPT 25608) or more (CPT 25609) fracture fragments.

It requires additional procedure details for open (CPT 25652) or percutaneous (CPT 25651) treatment of ulnar styloid fractures, as well as external fixation, where relevant (CPT 20690).

Whether the physician detects it outside the joint (extra-articular fracture) or inside (intra-articular fracture), one must document the fracture. The fracture pieces involved radial styloid fragments, volar ulnar, and dorsal ulnar fragments.

A 7.5 cm longitudinal incision is made along the anterolateral side of the distal forearm by the surgeon. The physician exposes the fracture by dividing between the planes of the lateral wrist muscles and tendons while safeguarding the median nerve.

He separates the radius from the pronator quadratus muscle. Then, the surgeon reduces the fracture or dislocation.

One/two screws connect a tiny T – Plate to the proximal fragment. Typically, no screw is placed through the distal portion of the Plate since it functions as a support and aids in keeping the fracture in reduction.

Execute direct viewing and separately reportable x-rays to validate proper joint surface reduction and repair. Replace the pronator quadratus at the radius of its origin.

Sutures, staples, or Steri-strips repair the wound in layers. In a cast, the arm is immobile.

CPT 25607 narrates the open treatment of distal radial extra-articular fracture or epiphyseal separation with internal fixation.

CPT 25608 narrates the open treatment of distal radial intra-articular fracture or epiphyseal separation with internal fixation of 2 fragments.

CPT 25609 narrates the open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments.

These codes varied depending on whether the surgery necessitated extra-articular (CPT 25607) or intra-articular (CPT 25608, CPT 25609) repair. They further distinguish the CPT codes 25608 and 25609 by the number of fragments requiring internal fixation.

CPT 25608 indicates fractures require fixing of one or two segments, and code 25609 indicates fractures requiring fixation of three or more fractures.

Medical illustration (CPT 25607): A 40 – year – older woman falls while dancing and sustains a displaced extra-articular metaphyseal fracture of the distal radius. The surgeon performs an open reduction of the extra-articular metaphyseal.

In this case, the coder must use CPT 25607, a more relevant code. The global period for CPT 25607 is 90 – days.

Medical illustration (CPT 25608): A 30 – year – older man falls off his motorcycle and has a displaced fracture of his radial styloid. A surgeon performs open surgery on the distal radial intra-articular fracture with internal fixation of two fragments.

The coder or biller must use the most appropriate code, CPT 26508. The global period of CPT 25608 is 90 – days.

Medical illustration (CPT 25609): A 60 – year – older woman slips on a road and collapses on her outstretched upper limb, sustaining a four-part intra-articular distal radius fracture. A surgeon performs the surgery with the open treatment of the distal radial intra-articular fracture as the patient had received a 4 – part intra-articular distal radius fracture.

Hence, CPT 25609 is relevant because CPT 25609 description covers the internal fixation of 3 or more fragments. The global period of CPT 25609 is 90 – days.

CPT 01830 narrates as the provider administers anesthesia to a patient with surgery on the distal radius, distal ulna, wrist, or hand joints. He may then operate utilizing an open approach or an arthroscopic/endoscopic method.

The provider can use CPT 01830 for an anesthetic technique that another CPT does not cover.

As per CMS, the fee for these procedures are as follows:

The Physician Fee Schedule (PFS) for CPT 25607 is $760.64 for the facility and non-facility.

The Physician Fee Schedule (PFS) for CPT 25608 is $851.31 for the facility and non-facility.

The Physician Fee Schedule (PFS) for CPT 25609 is $1080.41 for the facility and non-facility.

Modifiers

The following are modifiers commonly used for accurate reimbursement purposes related to ORIF distal radius CPT.

Utilize modifier 22 when the distal radius ORIF operation takes longer than the regular time.

Use Modifier 51 when the physician has performed multiple procedural operations in the same session (time).

Utilize Modifier 52 when the physician accomplished partially reduced services due to some circumstance.

When the physician stops a surgical or diagnostic procedure after beginning due to unforeseen circumstances, use modifier 53.

When performing the course of action during a global period, use modifier 58. It may be staged or related to a service executed by the same provider or another health care provider during the postoperative period.

Use Modifier 59 when carrying out other distinct procedural services other than E/M.

Use Modifier 78 when a patient has an unplanned return to the operating room by the same health care professional following an initial procedure for a related method during the postoperative period.

Use Modifier 79 when a physician performs an unrelated procedure or service provided by the same provider or other qualified health care provider during the postoperative period.

CPT Code Distal Radius ORIF Examples

The physician sent the patient to the operating room. After receiving successful general anesthesia, he removed the splint from the left upper extremity.

The skin was in terrific form. Inflammation and acute ecchymosis were to expect.

They placed a tourniquet around the left upper arm; The left upper arm, forearm, and hand were prepared and draped; They raised the tourniquet after gravity exsanguination. The physician utilized fluoroscopy to assess the reduction potential.

It was conceivable; however, the instant collapse happened as soon as the reduction force was released. They made a tangential radial incision along the flexor carpi radialis tendon and the distal wrist crease; It continued tangentially radially onto the thenar eminence.

The incision was traced into the subcutaneous layers, revealing the tendon. They then straightened the tendon radially to preserve the neurovascular bundle.

Next, an incision was carried out further down the flexor tendon to the fracture; that had ruptured the muscle. Finally, physicians used Homan retractors to separate the muscle tissue proximally so that they dissect the tissue away.

For removal of the clot, they extensively drain the fracture. The physicians then reduced the fracture using force and chose a Volar Plate.

The physician inserted two pins and recorded preliminary x-rays. Next, the surgeon inserted the screw into the sliding screw hole.

The surgeon then adjusted the Plate under fluoroscopic control to achieve optimal stability. After that, the practitioner screwed the screw into position.

Seven locking screws were then inserted into the distal part of the Plate to retain the numerous pieces in place and, after that, inserted the last big screw in the Volar Plate. Again, the final scans showed the anticipated reduction.

The fragments stayed in place while practitioners moved the wrist through its range of motion under fluoroscopy.

The area was then thoroughly rinsed. Interrupted 2-0 Vicryl was used to restore the flexor volar surface and interrupted 2-0 Vicryl was used to seal the subcutaneous tissue.

Next, they used 3-0 nylon to close the skin. Next, the physicians injected analgesics along the skin’s edge for postoperative analgesia.

After that, they placed a sterile dressing with a volar splint. When the specialist removed the tourniquet, all the fingers instantly pinked. The patient was woken and sent to the recovery area in good condition, having tolerated the treatment well.

The whole report indicates the overview of the ORIF distal radius procedure performed. The coder or biller must employ CPT 25609 for this procedure.

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