Overview of CPT Code 25490: Open treatment of distal radius fracture

CPT Code 25490 refers to the surgical procedure for the open treatment of a fracture in the distal radius, which is the larger of the two bones in the forearm. This procedure is typically performed when a fracture is displaced or unstable, requiring surgical intervention to realign and stabilize the bone.

When CPT Code 25490 is Used?

This code is applicable in various clinical scenarios, including:

Displaced distal radius fractures that cannot be aligned properly through closed reduction.
Fractures with associated instability that require surgical fixation.
Fractures resulting from high-energy trauma, such as falls or accidents.
Fractures in patients with significant wrist deformity or dysfunction.

Symptoms Indicating This Procedure

Patients may present with the following symptoms:

Severe pain in the wrist area.
Swelling and bruising around the fracture site.
Deformity or abnormal positioning of the wrist.
Inability to move the wrist or fingers.
Numbness or tingling in the hand or fingers.

Causes and Risk Factors

Several factors can contribute to the occurrence of distal radius fractures:

Falls, particularly in older adults.
Sports injuries, especially in contact sports.
Osteoporosis, which weakens bones and increases fracture risk.
High-impact accidents, such as motor vehicle collisions.

Diagnostic Tests Before Procedure

To confirm the diagnosis and plan for surgery, the following tests may be performed:

X-rays to visualize the fracture and assess its alignment.
CT scans for detailed imaging of complex fractures.
MRI in cases where soft tissue injury is suspected.

Procedure Description

The open treatment of a distal radius fracture involves several key steps:

Administer anesthesia to ensure patient comfort.
Make an incision over the fracture site to access the bone.
Realign the fractured bone fragments into their proper position.
Stabilize the fracture using plates, screws, or pins.
Close the incision with sutures and apply a dressing.

Preparation for the Procedure

Patients should follow these steps before undergoing the procedure:

Discuss any medications with the surgeon, especially blood thinners.
Avoid eating or drinking for a specified period before surgery.
Arrange for transportation to and from the surgical facility.
Wear loose-fitting clothing on the day of the procedure.

Recovery and Aftercare

Post-operative recovery typically involves:

Wearing a splint or cast for several weeks to immobilize the wrist.
Managing pain with prescribed medications.
Attending follow-up appointments to monitor healing.
Engaging in physical therapy to regain strength and mobility.

Possible Complications

While complications are rare, they can occur and may include:

Infection at the surgical site.
Nerve or blood vessel damage.
Nonunion or malunion of the fracture.
Stiffness or loss of motion in the wrist.

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Post-Procedure Follow-Up

Follow-up care is crucial for successful recovery:

Initial follow-up within 1-2 weeks post-surgery to check the incision.
Subsequent visits every 4-6 weeks to monitor bone healing.
Physical therapy sessions as recommended by the surgeon.

Alternative Treatments

In some cases, non-surgical options may be considered:

Closed reduction and casting for non-displaced fractures.
Physical therapy for rehabilitation without surgery.
Pain management strategies, including rest and ice.

Home Care Tips

Patients can follow these tips for effective home care:

Keep the wrist elevated to reduce swelling.
Apply ice packs to the area as directed.
Follow medication instructions carefully.
Avoid strenuous activities until cleared by the doctor.

Patient Education & Prevention

To prevent future fractures, consider these points:

Engage in weight-bearing exercises to strengthen bones.
Ensure adequate calcium and vitamin D intake.
Use protective gear during sports and high-risk activities.
Take precautions to prevent falls, especially in older adults.

Billing and Coding Information

CPT Code: 25490

Category: Surgery

Common Modifiers:

50 - Bilateral procedure
RT - Right side
LT - Left side

Average Cost and Insurance Coverage

The cost of the procedure can vary widely:

Average cost ranges from $5,000 to $15,000 depending on facility and complexity.
Most insurance plans cover the procedure if deemed medically necessary.
Patients should verify coverage details with their insurance provider.