Summary & Overview
CPT 25575: Open Treatment of Both-Bone Forearm Shaft Fractures
CPT code 25575 represents open surgical treatment of a both-bone forearm fracture, addressing fractures of the shafts of both the radius and ulna with direct visualization, reduction, and fixation. Nationally, this code matters because it captures a common orthopedic trauma procedure with implications for surgical resource use, facility utilization, and payer coverage policies for fracture fixation.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how these payers classify and reimburse open both-bone forearm repairs, typical places of service, and common billing considerations tied to this procedure.
Readers will learn clinical context for when CPT code 25575 is used, expected settings of care (hospital OR or ambulatory surgery center), and common billing elements associated with operative fixation of both-radius-and-ulna shaft fractures. The report outlines benchmark payment patterns and policy considerations at a national level, highlights documentation points that support use of this code, and notes where additional clinical detail or diagnosis linkage is commonly required by payers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 25575 describes an open treatment of a both-bone forearm fracture, involving surgical exposure and realignment of the shafts of the radius and ulna. The procedure typically includes making an incision to directly visualize the fracture sites, performing reduction of both bones, and applying fixation hardware as needed to stabilize the fractures.
Service Type: Open surgical fracture repair (both bones, forearm)
Typical Site of Service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 38-year-old male presents to the emergency department after a motorcycle collision with severe forearm pain, visible deformity of the mid-forearm, swelling, and focal tenderness. Neurovascular exam reveals intact distal pulses and preserved motor and sensory function. Radiographs demonstrate displaced both-bone fractures of the radial and ulnar shafts. The orthopedic trauma surgeon schedules an urgent open reduction and internal fixation to realign and stabilize both fractures.
Preoperative workflow includes focused history and physical, neurovascular assessment, radiographic review, informed consent, and anesthesia evaluation (regional block or general). In the operating room the surgeon makes a forearm incision, performs open reduction of the radius and ulna, and applies appropriate internal fixation such as plates and screws or intramedullary devices. Postoperative care includes neurovascular checks, pain control, immobilization in a splint or cast, radiographic confirmation of alignment, and outpatient follow-up for wound check and early rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and effort significantly exceed typical requirements due to complexity (document rationale). |
| 24 | Data not available in the input. | Data not available in the input. |