2025 CPT code 25628
(Active) Effective Date: N/A Revision Date: N/A Surgery - Fracture and/or Dislocation Treatment Musculoskeletal System Feed
Open treatment of a scaphoid fracture, including internal fixation when performed.
Modifiers may be appended to 25628 as per current CPT guidelines. Examples include modifier 54 (surgical care only) if the physician performs the surgery but does not provide post-operative care, modifier 76 (repeat procedure) if the same physician re-operates, and others depending on the specifics of the situation.
Medical necessity is established by the presence of a displaced scaphoid fracture that requires surgical intervention for proper healing and restoration of wrist function. Non-operative management is often not sufficient for displaced fractures due to the risk of nonunion (failure to heal) or malunion (improper healing).
The physician is responsible for all aspects of the surgical procedure, including preoperative assessment, surgical intervention (incision, reduction, fixation), post-operative imaging, and application of immobilization (cast/splint).
In simple words: The doctor performs surgery to fix a broken scaphoid bone (a small bone in your wrist). This involves making an incision, putting the broken pieces back together, and using small metal pieces (wires or screws) to hold them in place while they heal.A cast or splint is then applied.
This CPT code encompasses the open surgical treatment of a scaphoid fracture in the wrist.The procedure involves a surgical incision to access the fracture site, reduction (realignment) of the fractured bone fragments, and internal fixation using devices like wires or screws to stabilize the bone during healing.Post-operative imaging (radiography) is typically included to verify proper reduction.The application of a cast or splint to immobilize the wrist is also considered part of this procedure.
Example 1: A 25-year-old male falls during a skateboarding accident and sustains a displaced scaphoid fracture.Open reduction and internal fixation (ORIF) with screw fixation is performed. A long arm thumb spica cast is applied postoperatively. , A 40-year-old female experiences a fall resulting in a comminuted (multiple bone fragments) scaphoid fracture. ORIF is performed using multiple small screws.Post-operative imaging confirms satisfactory alignment.A short arm cast is applied., A 16-year-old male sustains a displaced scaphoid fracture in a sports injury. Open reduction and internal fixation using Kirschner wires (K-wires) are performed. A long arm cast is applied.The patient is advised on post-operative care and follow-up appointments.
* Preoperative diagnosis including imaging studies (X-rays) showing the fracture.* Operative report detailing the surgical technique, implants used (type and number of screws/wires), and intraoperative findings.* Postoperative X-rays confirming adequate reduction and fixation.* Documentation of the type of cast/splint applied.* Post-operative instructions given to the patient.
** Accurate coding requires comprehensive documentation of the surgical procedure, including the type of fracture, the technique used for reduction and fixation, and post-operative care.
- Revenue Code: P5B (AMBULATORY PROCEDURES - MUSCULOSKELETAL)
- Global Days : 90 days
- Payment Status: Active
- Modifier TC rule: The TC (technical component) modifier may be applicable depending on the payer and circumstances of the service delivery.
- Specialties:Orthopedic Surgery, Hand Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient