Summary & Overview
CPT 25425: Forearm Bone Defect Repair with Autograft
CPT code 25425 denotes surgical repair of a defect in the radius or ulna using excision and reconstruction with the patient’s own bone graft. This procedure addresses defects arising from trauma, bone disease, or prior surgery and has significant implications for functional recovery of the forearm and wrist. Nationally, such reconstructive procedures affect hospital surgical caseloads, resource utilization in orthopedic services, and postoperative care pathways.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical sites of service, alongside benchmarking context and payer coverage considerations. The report outlines coding specificity, common billing modifiers, and areas where documentation supports medical necessity for autogenous bone grafting in the forearm.
The publication provides clinicians, coding professionals, and payers with practical context: clinical scenarios that typically generate use of CPT code 25425, expected service settings, and elements of documentation and billing that influence coverage and payment. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 25425 describes a surgical procedure to treat a defect of the radius or ulna of the lower arm by excision of the lesion and reconstruction with an autogenous bone graft. Service type: Operative bone defect reconstruction with autograft. Typical site of service: Hospital operating room or ambulatory surgical center for orthopedic surgery involving the forearm.
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old male who presents with a nonhealing post-traumatic segmental bone defect of the distal radius after open reduction internal fixation (ORIF) complicated by bone loss and infection clearance. The patient has persistent pain, instability, and radiographic evidence of a cortical and cancellous defect requiring structural reconstruction. After preoperative evaluation including plain radiographs and CT to define defect size and assessment by the orthopedic surgeon, the planned procedure is excision of the nonviable bone and reconstruction of the radial defect using an autogenous bone graft (iliac crest) with internal fixation as needed.
The clinical workflow includes preoperative consent and optimization, anesthesia evaluation (general or regional block), harvesting of autogenous graft (commonly from the iliac crest), debridement/excision of the defect in the radius or ulna, placement and fixation of the bone graft into the defect with internal fixation (plate/screws or fixation pins), intraoperative imaging to confirm alignment and hardware position, wound closure, and postoperative care including immobilization and outpatient follow-up with serial radiographs to confirm graft incorporation and bone healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, technical difficulty or severity of patient condition is substantially greater than typically required for . Documentation must justify the increased services. |