Basics of ORIF distal Radius CPT codes
ORIF stands for Open Reduction Internal Fixation. Distal radial fractures can be very complex. Open treatment of a distal radial fracture is significantly more complex today than when the CPT code for open reduction and internal fixation was originally introduced, due to new technology (eg, fracture specific fixation, fixed angle plate fixation) and the awareness that distal radial fractures require accurate repair. We have separate ORIF distal radius CPT codes in surgery facility.
Distal radial fractures can be classified as follows:
- Extra-articular or intra-articular
- Displaced or undisplaced
- Simple or complex
- Two part
- Three part
- Four part
- Comminuted
- With or without sigmoid notch involvement
Open treatment of these fractures can be accomplished with:
- Plates
- Screws
- Pins or Kirschner wires
- Intramedullary rods
- Combinations of plates, screws, pins, and wires
Open treatment can be accomplished through (a) one incision (dorsal or palmar) or (b) two or more incisions (dorsal and/or palmar)
Procedure Performed for ORIF distal radius CPT codes
The physician makes a 7.5 cm longitudinal incision along the anterolateral aspect of the distal forearm. The physician exposes the fracture by dissecting between the planes of muscles and tendons of the lateral wrist area while protecting the median nerve. The pronator quadratus muscle is severed from the radius. The physician reduces the fracture or separation. A small T-plate is fixed to the proximal fragment with one or two screws. Usually no screw is inserted through the distal part of the plate since it acts as a buttress and helps hold the fracture in reduction. Direct visualization and separately reportable x-rays are used to confirm correct reduction and restoration of the joint surface. The pronator quadratus is replaced at its origin on the radius. The incision is repaired in layers using sutures, staples, and/or Steri-strips. The arm is immobilized in a cast. CPT code 25607 is reported for open treatment of the fracture with internal fixation; CPT code 25608 for fracture repair in which two fragments of bone in the joint receive internal fixation; and CPT code 25609 for fracture repair in which three or more fragments of bone in the joint receive internal fixation.
Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation, includes release of the brachioradialis tendon.
25607 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation
25608 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments
25609 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments
These codes are differentiated according to whether the procedure required extra-articular (25607) or intra-articular (25608, 25609) repair. Codes 25608 and 25609 are further differentiated according to the number of fragments requiring internal fixation, with code 25608 describing fractures that require fixation of one or two fragments, and code 25609 describing fractures that require fixation of three or more fragments.
Clinical Example for ORIF distal radius CPT codes
Clinical Example (25607)
A 40-year-old female falls while inline-skating and suffers a displaced extraarticular metaphyseal fracture of the distal radius requiring open reduction and internal fixation.
Clinical Example (25608)
A 30-year-old male falls from his bike and suffers a displaced fracture of his radial styloid requiring open reduction and internal fixation.
Clinical Example (25609)
A 60-year-old female trips on a sidewalk and falls on her outstretched upper extremity suffering a four-part intra-articular fracture of the distal radius requiring open reduction and internal fixation.
Anesthesia Crosswalk
01830 Anesthesia, Open/Surg Arthroscopic/Endoscopic Proc, Distal Radius/Distal Ulna/Wrist/Hand; NOS