Orthopedic Coding Alert

Hint: Your physician's op report may cause you to select incorrect code

When CPT 2007 introduced three new distal radial fracture treatment codes, coders figured their lives would get immeasurably easier. But unexpected confusion has surrounded these codes, due to the terms -intra-articular- and -extra-articular- in the descriptors.

Get to Know the 2007 Codes

To help you determine which codes apply to your surgeon's operative reports, we-ve got a breakdown of the following new codes:

- 25606--Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation

- 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.

Understand Anatomic Differences to Select Code

The confusion is rooted in the fact that 25607 refers to an extra-articular fracture, while 25608-25609 describe intra-articular fractures. Although the differentiation initially seems obvious, many physicians do not specifically dictate whether they treated an intra-articular or extra-articular fracture, leading coders stumped at claim-submission time.

Here's the difference: -Intra-articular means the fracture extends into the joint,- says Douglas Hutchinson, MD, a practicing surgeon and associate professor at the University of Utah Orthopaedic Center. -Most distal radial fractures that require surgeries are intra-articular.-

-The distal radius articulates with the distal ulna and the proximal carpal row,- says Bill Mallon, MD, medical director at Triangle Orthopaedics in Durham, N.C.  -There are several joints there--the distal radio-ulnar joint (DRUJ), and the radio-carpal joints, technically the radio-scaphoid and radio-lunate joints. Thus, most distal radial fractures have some component that is intra-articular.

-Unless your surgeon specifically states that the fracture was extra-articular, it is most likely an intra-articular fracture,- Mallon says.

Look for Clues in the Op Note

In some cases, your surgeon may not dictate whether the fracture extends into the joint space, which will still leave you in the dark when it comes to choosing a code.

-The coder should make the surgeon aware of the new codes so the physician can remember to include the terminology in his dictation,- says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md.

You may be able to determine on your own if the surgeon documents certain terms in his op report. -Of course, if there is any mention of articular fragments or the articular surface, the surgeon treated an intra-articular fracture,- Follebout says. -In addition, if the surgeon discusses a -lunate fragment,- a -step-off- or anything about the chondral surfaces, it would be intra-articular.-

Count the Fragments for Intra-Articular Fractures

Once you-re certain that the surgeon treated an intra-articular fracture, you should further narrow your coding choices by determining how many fragments the surgeon had to secure using fixation.

-There are, by definition, two fragments at a minimum in all fractures,- Mallon says. -If your surgeon mentions -fragment-specific fixation,- which is a term now commonly used, it is likely that three or more fragments were fixated.-

Watch How Many Units to Report

Keep in mind: Report only one unit of 25609, even if the surgeon applies fixation to four or more fragments. You should not report additional units to denote extra fragments.