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The CPT® Code 25645 refers to the open treatment of a fracture involving one of the carpal bones, excluding the carpal scaphoid (navicular) bone. Carpal bones are the eight small bones that make up the wrist, arranged in two rows. The proximal row consists of the scaphoid, lunate, triquetrum, and pisiform, while the distal row includes the trapezium, trapezoid, capitate, and hamate. When a fracture occurs in any of these bones, it can be treated through various methods, including closed treatment without manipulation, closed treatment with manipulation, or open treatment. The open treatment approach, as indicated by this code, involves a surgical procedure where an incision is made to access the fracture site directly. This allows for the identification and cleaning of the fracture area, followed by the reduction of the fracture fragments to restore proper alignment. In some cases, internal fixation devices such as screws or wiring may be utilized to stabilize the fracture. It is important to note that if multiple carpal bones are fractured, each bone's treatment must be reported separately. Additionally, radiographs are typically obtained to confirm the presence and alignment of the fracture, and a neurovascular examination is performed to ensure the integrity of the nerves and blood vessels surrounding the injury.
© Copyright 2025 Coding Ahead. All rights reserved.
The open treatment of carpal bone fractures, as described by CPT® Code 25645, is indicated for specific conditions and symptoms associated with fractures of the carpal bones other than the scaphoid. These indications include:
The procedure for the open treatment of a carpal bone fracture involves several critical steps, which are detailed as follows:
After the open treatment procedure for a carpal bone fracture, the patient will typically undergo a period of recovery that includes monitoring for any signs of complications, such as infection or improper healing. The wrist will remain immobilized in a short arm cast or splint to ensure stability and support during the healing process. Follow-up appointments are necessary to assess the healing progress through radiographs and to make any adjustments to the treatment plan as needed. Rehabilitation exercises may be recommended once the fracture has sufficiently healed to restore range of motion and strength to the wrist.
| Short Descr | OPTX CRPL FX OTH/THN SCPH EA | Medium Descr | OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA | Long Descr | Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone | 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) | 0 - Co-surgeons not permitted for this procedure. | 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2025-01-01 | Changed | Short Description changed. |
| 2009-01-01 | Changed | Code description changed |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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