Summary & Overview
CPT 25490: Radius Defect Fixation with Internal Implants
CPT code 25490 represents surgical fixation of a defect in the radius using internal implants (nails, plates, screws), with optional use of methylmethacrylate bone cement. The code covers procedures to restore structural integrity of the forearm radius after defects such as nonunion, malunion, or traumatic bone loss. Nationally, this code is relevant to orthopedic surgeons, hospital billing departments, and payers because it encompasses complex reconstructive fixation that affects resource use, facility setting, and coding specificity.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, the typical service setting, and the payer landscape covered. The publication outlines benchmark considerations, common billing modifiers and service-line implications, and clinical context necessary for correct claim submission and adjudication. It highlights coding nuances tied to implant use and optional bone cement, and summarizes what to expect when preparing operative and billing documentation.
This summary is national in scope and designed to help clinical coders, revenue cycle professionals, and policy analysts understand where CPT code 25490 fits within orthopedic surgical billing and payer interactions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 25490 describes surgical treatment of a defect in the radius of the forearm using internal fixation implants such as nails, plates, or screws, with optional use of methylmethacrylate bone cement. This procedure addresses structural defects, nonunions, malunions, or other radius abnormalities requiring operative stabilization.
-
Service type: Surgical orthopedic fixation of radius defect
-
Typical site of service: Hospital inpatient or outpatient operating room, ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 45-year-old male presents with a nonunion fracture and segmental defect of the distal radius following a motor vehicle collision. After preoperative imaging (plain radiographs and CT) confirms bone loss and instability, the orthopedic surgeon schedules operative fixation. In the operating room under general anesthesia, the surgeon performs open reduction and internal fixation of the radius using plates and screws; methylmethacrylate bone cement may be used to fill a segmental defect if biologic grafting is not feasible. The typical workflow includes preoperative assessment, perioperative antibiotics, intraoperative fluoroscopic imaging to confirm alignment and hardware position, possible intraoperative bone grafting or cement augmentation, and postoperative immobilization with surgical follow-up for wound checks and radiographic surveillance until radiographic union is achieved. Typical site of service is the hospital operating room or ambulatory surgery center. Common payors for claim adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons on distinct portions of a complex radius reconstruction. |
76 |