2023 ASC Coding Tips: Distal Radius Fractures

By Mandeara Frye, RHIA, CPC, CPMA, CRC, CASCC, Senior Director, Coding

Distal radius fracture treatment coding seems fairly straightforward to most, but with payers cracking down on documentation requirements, it’s worth reviewing the code options and requirements. There are several types of distal radius fractures (e.g., Barton’s, Colles’, Salter-Harris). For this column, we are focusing on two major distinctions: extraarticular versus intraarticular. First, here are key terms to understand when coding these procedures.

Fracture Definitions

Extraarticular: a fracture that does not enter the joint (extra = outside, articular = joint)

Intraarticular: a fracture line that extends into the joint (intra = inside)

Closed fracture: the skin remains intact; also known as a simple fracture

Open fracture: the broken bone protrudes through the skin; also known as a compound fracture

Comminuted fracture: a bone that is broken into three or more pieces (i.e., fragments)

Closed treatment: the fracture is reduced and/or manipulated without needing an open incision or internal hardware/fixation

Percutaneous treatment: the fracture is treated by placing wires and/or screws without an open incision

Open treatment: the fracture treatment requires an open incision to reduce the fracture and place hardware (internal fixation)

Extraarticular Fracture Coding

CPT selection for extraarticular fractures should be based on the type of fracture treatment required (closed, percutaneous, or open).

• 25605 — Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation
• 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

Intraarticular Fracture Coding

CPT selection should still be based on the type of fracture treatment required (closed, percutaneous, or open), but there is an added element for open fracture treatment: the number of fragments that receive internal fixation. In addition to CPT 25605 for closed treatment and CPT 25606 for percutaneous treatment, intraarticular fractures may also be coded with the following codes:

• 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

It’s important for the documentation to specify the number of fracture fragments that are being fixated. It is not sufficient for the surgeon to simply state there were three fragments in the diagnosis field. The details of the procedure performed must include the specifics of what is being done. If this information is not included, the coder will need to query the physician for confirmation.

It’s also worth noting that the type of fracture (open or closed) does not drive the method of treatment (open or closed). Closed fractures are often treated with open reduction of the fracture and open fractures may be treated using closed techniques on the bone. It’s important for the coder to understand the anatomy, techniques, and correct coding pathways.

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