Overview of CPT Code 25526: Open treatment of distal radius fracture

CPT Code 25526 refers to the open treatment of a fracture of 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 25526 is Used?

This code is applicable in various clinical scenarios, including:

Displaced distal radius fractures that cannot be aligned properly with non-surgical methods.
Fractures associated with significant wrist instability.
Fractures that have not healed properly with conservative treatment.
Fractures resulting from high-energy trauma, such as falls or accidents.

Symptoms Indicating This Procedure

Patients may present with the following symptoms:

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

Causes and Risk Factors

Understanding the causes and risk factors can help in prevention and management.

Falls, particularly in older adults.
Sports injuries, especially in contact sports.
Osteoporosis, which weakens bones.
High-impact accidents, such as car crashes.

Diagnostic Tests Before Procedure

Several diagnostic tests may be performed to confirm the need for surgery:

X-rays to visualize the fracture and 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 to prepare for surgery:

Avoid eating or drinking after midnight before the surgery.
Discuss any medications with the surgeon, especially blood thinners.
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.
Taking prescribed pain medications as needed.
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 optimal recovery:

Initial follow-up within 1-2 weeks post-surgery.
Regular check-ups every few weeks to assess healing.
Physical therapy sessions as recommended by the surgeon.

Alternative Treatments

Non-surgical options may be considered in certain cases:

Casting or splinting for non-displaced fractures.
Physical therapy to strengthen the wrist.
Pain management with medications.

Home Care Tips

Patients can follow these tips for better recovery at home:

Keep the wrist elevated to reduce swelling.
Apply ice packs to the area to alleviate pain.
Follow the surgeon's instructions regarding activity restrictions.
Maintain a healthy diet to support healing.

Patient Education & Prevention

Educating patients on prevention can reduce recurrence:

Engage in strength training to improve bone health.
Use protective gear during sports activities.
Take precautions to prevent falls, especially in older adults.

Billing and Coding Information

CPT Code: 25526

Category: Surgery

Common Modifiers:

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

Average Cost and Insurance Coverage

Costs can vary based on several factors:

Average cost ranges from $5,000 to $15,000 depending on facility and complexity.
Most insurance plans cover the procedure, but patients should verify with their provider.