Summary & Overview
CPT 25492: Forearm Radius and Ulna Reconstruction with Internal Fixation
CPT code 25492 covers surgical reconstruction of defects in the radius and ulna with internal fixation using nails, plates, or screws, with optional use of methylmethacrylate bone cement. This code captures a clinically significant set of orthopedic procedures used to restore forearm anatomy, maintain stability, and prevent future functional impairment. Nationally, these reconstructions are important for trauma repair, nonunion correction, and complex reconstructive cases that affect patient mobility and quality of life.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications, typical sites of service, and the procedural components associated with the code. The publication outlines expected utilization contexts, common billing modifiers (listed separately), and how CPT code 25492 fits within broader orthopedic surgical coding practice.
This report provides benchmarks and service-line context relevant to hospitals, ambulatory surgery centers, and orthopedic practices, and summarizes policy and coverage considerations that commonly affect authorization and payment. Data not available in the input is noted where applicable; clinical context and operational implications are presented for a national audience without state-specific references.
Billing Code Overview
CPT code 25492 describes surgical reconstruction of the radius and ulna in the forearm to correct a defect, using internal fixation implants such as intramedullary nails, plates, or screws. The procedure may include the use of methylmethacrylate bone cement but does not require it.
Service type: Orthopedic reconstructive surgery
Typical site of service: Inpatient or outpatient surgical setting (operating room or ambulatory surgery center) depending on patient condition and procedural complexity.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old manual laborer who sustained an acute open or closed fracture of the radius and/or ulna after a fall from a ladder. He presents to the emergency department with forearm deformity, swelling, and pain. After initial radiographs confirm diaphyseal fractures of the radius and ulna with displacement and instability, the patient is consented for operative fixation. The clinical workflow includes preoperative evaluation, imaging (AP and lateral radiographs; CT if complex), preoperative antibiotics and anesthesia evaluation, operative fixation using plates, screws, and/or intramedullary nails with optional use of bone cement (methylmethacrylate) if indicated for structural augmentation, intraoperative fluoroscopy to confirm reduction and hardware position, and postoperative immobilization and outpatient follow-up with radiographs to monitor healing. The procedure may occur in an inpatient or outpatient ambulatory surgery center depending on soft tissue status, patient comorbidities, and facility capabilities. Typical postoperative care includes pain management, wound checks, occupational therapy for range of motion and strengthening, and return-to-work guidance based on healing and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, technical difficulty, or severity substantially exceeds typical for the procedure. |