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CPT 25605 - Distal Radius and Ulna Question


West Los Angeles
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If a patient presents with a distal radial fracture and a distal ulnar fracture not specified as an ulnar styloid fracture, and both are reduced, can CPT 25605 be applied or would CPT 25565 be more appropriate?

The CPT book indicates "Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed, with manipulation." The description does not indicate distal ulnar so I want to make sure this CPT is not specific to an ulnar styloid fracture.

Any feedback would be appreciated.


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I personally would use 25605. The distal radius is the main bone that is being manipulated. Also, the ulnar styloid is the typical location of the associated ulnar fracture which may or may not need separate manipulation.


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The first thing you need is a thorough and accurate description of both the distal radial and distal ulnar fractures, as each bone fracture requires its own ICD-10 Diagnosis code, i.e. 2 codes to complete the diagnosis coding. In other words, "Unspecified" distal ulnar fracture doesn't cut it. The most commonly associated fracture of the distal ulna in the presence of a distal radius fracture is the ulnar styloid, which may be undisplayed/nondisplaced or displaced.

As for the closed reduction/manipulation of the fractures, the primary attention is toward the distal radius fracture, and the distal ulnar styloid fracture sort of "goes along for the ride" when the radius is reduced, so that its treatment is included in the 25605 procedural code. If the distal ulnar fracture is not a styloid fracture, but is of the ulnar head or neck, then it my or may not require specific attention in the treatment/reduction process. If it reduces well along with the distal radius after manipulation, then it would still be included in the 25605 code.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.