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The CPT® Code 25420 refers to the surgical procedure for the repair of a nonunion or malunion of both the radius and ulna, which involves the use of an autograft. A nonunion occurs when the fracture fragments fail to heal together after an adequate period, while a malunion refers to the improper alignment of the fracture fragments, leading to potential complications such as osseous abnormalities, incongruity of articular surfaces, soft tissue contracture, and nerve impingement. During this procedure, the original fracture sites of the radius and ulna are surgically exposed to assess the condition of the nonunion or malunion. The evaluation determines the necessary repair approach, which may involve internal fixation techniques, with or without the addition of a bone graft. In cases where internal fixation is performed without a graft, a compression plate may be utilized to stabilize the fracture. For nonunions, a compression plate is applied over the fracture site and secured with lag screws, while malunions may require refracturing and realignment of the radius and ulna, followed by internal fixation to maintain proper anatomical alignment. If a bone graft is indicated, the site is prepared, which may involve refracturing the bone to facilitate healing. An autograft is typically harvested from the iliac crest, where a skin incision is made, and muscle is stripped to expose the bone surface for harvesting cortical and/or cancellous bone. The harvested bone is then shaped to fit the defect, or cancellous bone may be morcellized and packed into the defect. Internal fixation devices, such as pins or wires, may be used to secure the graft, and a compression plate along with screws or other fixation methods is employed to stabilize the fracture effectively.
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The procedure described by CPT® Code 25420 is indicated for the following conditions:
The procedure for CPT® Code 25420 involves several critical steps to ensure effective repair of the nonunion or malunion of the radius and ulna:
After the completion of the procedure, the patient will require careful monitoring and follow-up care. Post-operative care may include pain management, wound care, and physical therapy to restore function. The expected recovery time will vary based on the individual patient's condition and the extent of the surgical intervention. Regular follow-up appointments are essential to assess the healing process and ensure that the fracture is stabilizing correctly. Radiographic evaluations may be performed to confirm proper alignment and integration of the graft, if used. Patients should be advised on activity restrictions and rehabilitation protocols to promote optimal recovery.
| Short Descr | REPAIR/GRAFT RADIUS & ULNA | Medium Descr | RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT | Long Descr | Repair of nonunion or malunion, radius AND ulna; with autograft (includes obtaining graft) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 145 - Treatment, fracture or dislocation of radius and ulna |
This is a primary code that can be used with these additional add-on codes.
| 20703 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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