Summary & Overview
CPT 25526: Open Repair of Radial Shaft Fracture with DRUJ Dislocation and TFCC Repair
CPT code 25526 represents an open surgical repair for a radial shaft fracture performed in combination with displacement of both forearm bones at the wrist or the distal radioulnar joint, including repair of the triangular fibrocartilage complex (TFCC) as needed. This code captures complex forearm and wrist trauma requiring operative fixation and soft-tissue repair and is relevant to orthopedics, hand surgery, and trauma services nationwide. It matters nationally because it denotes a higher-acuity operative service with implications for surgical resource use, reimbursement, and post-operative care pathways.
Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context explaining the procedure elements and typical sites of service, as well as billing and coding considerations tied to operative fixation and TFCC repair. The publication provides benchmarks and payer coverage patterns where available, summarizes policy developments affecting payment or preauthorization, and highlights common documentation elements required to support medical necessity. Data not available in the input will be plainly noted in relevant sections. The content is intended for national audiences including coding professionals, surgeons, and policy analysts seeking a concise reference on CPT code 25526.
Billing Code Overview
CPT code 25526 describes an open surgical procedure to repair a fracture of the shaft of the radius combined with a distal radioulnar joint or wrist dislocation, when both forearm bones are displaced. The procedure involves making an incision to reduce and fix the radial shaft fracture and to address the dislocation at the wrist or distal radioulnar joint, with application of internal fixation hardware as needed. The repair also includes restoration of the triangular fibrocartilage complex (TFCC) when indicated.
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Service type: Open orthopedic surgical repair of radial shaft fracture with concomitant distal radioulnar joint/wrist dislocation and TFCC repair
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who sustained a high-energy fall onto an outstretched hand or direct blow to the forearm and presents with acute pain, deformity, swelling, and loss of wrist/forearm function. Imaging (radiographs, often CT) demonstrates a displaced fracture of the radial shaft combined with a distal radioulnar joint (DRUJ) dislocation and associated triangular fibrocartilage complex (TFCC) injury. The clinical workflow includes emergency evaluation, neurovascular exam, analgesia and immobilization in a splint, preoperative imaging, informed consent, and scheduling for open surgical repair. In the operating room the surgeon makes an open incision to reduce and internally fix the radial shaft fracture (plate and screws or intramedullary fixation as appropriate), reduces and stabilizes the DRUJ (temporary K-wire or repair of TFCC), performs repair of the TFCC when indicated, verifies stability under fluoroscopy, closes wounds, and applies a sterile dressing and postoperative immobilization. Postoperative care includes pain control, infection surveillance, hand therapy, and serial radiographs to confirm healing and joint alignment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left forearm/wrist. |
RT |