Summary & Overview
CPT 25515: Open Treatment of Radius Shaft Fracture, With Fixation
CPT code 25515 denotes the open surgical treatment of a fracture of the shaft of the radius, typically involving incision to expose the fracture and placement of internal fixation hardware when indicated. This code is central to orthopedic trauma care for forearm fractures and carries implications for surgical resource use, operative time, and implant costs. Nationally, it matters because it captures definitive operative management of diaphyseal radial fractures across inpatient and ambulatory surgical settings.
Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and typical sites of service, common billing considerations, and benchmarking focus areas. The publication outlines expected service lines and how this code aligns with surgical management pathways for radius shaft fractures.
This summary prepares clinicians, coding professionals, and policy analysts to understand where 25515 fits into orthopedic procedural coding, what operational elements it represents, and which payers commonly cover the service. Data not available in the input is noted where applicable; the content emphasizes clinical description, payer scope, and areas for further billing and policy review without providing state-specific guidance.
Billing Code Overview
CPT code 25515 describes an open treatment of a fracture of the shaft of the radius. The procedure involves a surgical incision through the forearm to directly access the fractured radial shaft and apply fixation hardware as needed to stabilize the bone for healing.
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Service type: Surgical open fracture treatment with internal fixation as indicated
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old male construction worker presents to the emergency department after a fall from scaffolding with severe forearm pain, visible deformity, and impaired wrist motion. Imaging confirms a displaced, angulated fracture of the radial shaft. After preoperative evaluation and informed consent, the patient is taken to the operating room for an open reduction and internal fixation of the radial shaft fracture under general anesthesia. The surgical team makes a forearm incision, achieves anatomic reduction, and applies a plate and screws to stabilize the radius. Postoperative workflow includes recovery room monitoring, pain control, neurovascular checks, discharge planning with immobilization instructions, and arranged orthopedic follow-up for wound check and radiographic union assessments. Typical site of service is an ambulatory surgery center or hospital operating room. The service type is operative orthopedic surgery (open fracture repair with internal fixation) for traumatic radial shaft fracture.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated E/M service by the same physician during a postoperative period | Use when an unrelated evaluation and management service is provided during the global surgical period (Note: 24 was not in provided list; follow strict rules: Data not available in the input.) |