Summary & Overview
CPT 25426: Radius and Ulna Reconstruction with Autologous Bone Graft
CPT code 25426 represents surgical reconstruction of defects in the radius and ulna using the patient’s own bone grafts. This operative code applies to procedures that excise devitalized or diseased bone and reconstruct the lower forearm to restore stability and function. Nationally, codes for complex upper-extremity reconstruction are important for surgical case-mix, reimbursement policy, and quality measurement because they reflect resource-intensive procedures with potential implications for postoperative rehabilitation and complication management.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, the typical site of service, and an outline of common billing modifiers associated with surgical services. The publication covers benchmarking elements such as expected service setting and clinical indications, summarizes payer coverage patterns where available, and flags policy considerations relevant to authorization and coding accuracy. Data not available in the input is noted where applicable. The content is intended to inform coding professionals, surgical providers, and policy analysts about the code’s clinical role, billing context, and areas where payer rules frequently affect claims processing.
Billing Code Overview
CPT code 25426 describes surgical treatment of defects in the distal forearm involving the radius and ulna. The procedure involves excision of pathologic or nonviable bone and reconstruction using autologous bone grafts harvested from the patient. The operation addresses defects formed due to trauma, bone disease, or prior surgery and typically includes fixation of the graft to restore structural integrity.
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Service type: Surgical open reconstruction with autologous bone grafting of the radius and ulna
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Typical site of service: Operating room in an acute care hospital or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old male who presents with a chronic nonunion and segmental bone defect of the distal radius and ulna after a high-energy distal forearm fracture sustained 6 months earlier. The patient reports persistent instability, pain with forearm rotation, and loss of function despite prior open reduction and internal fixation and a course of conservative management. Imaging (plain radiographs and CT) demonstrates a segmental osseous defect with sclerosis of margins and inadequate bridging callus. The orthopedic surgeon plans surgical management with excision of the nonviable bone ends, debridement of devitalized tissue, and reconstruction of the bone defect using autologous cancellous and corticocancellous bone graft harvested from the iliac crest. The procedure includes fixation of the radius and/or ulna with internal fixation (plates and screws or intramedullary devices) to restore length and alignment.
Preoperative workflow includes history and physical, informed consent, surgical planning with templating and imaging review, and anesthesia evaluation. Intraoperative steps include positioning, tourniquet as indicated, exposure of defect, excision of nonviable bone, harvest of autologous graft, graft placement and fixation, hemostasis, and wound closure. Postoperative workflow involves immediate recovery, pain control, immobilization (splint or cast), radiographic confirmation of graft position and hardware, and scheduled follow-up for wound checks, imaging to assess incorporation, and rehabilitation for range of motion and strengthening.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |