Summary & Overview
CPT 25628: Open Fixation of Scaphoid Fracture
CPT code 25628 denotes open surgical treatment of a scaphoid fracture with direct exposure of the carpal bone and internal fixation as indicated. Scaphoid fractures are common wrist injuries that can impair wrist function and require precise surgical management to restore anatomy and prevent nonunion. Nationally, this procedure represents a focused orthopedic hand/wrist operative service performed in hospital operating rooms and ambulatory surgery centers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 25628, typical sites of service, and the common billing modifiers associated with operative hand surgery. The publication summarizes payer coverage patterns and utilization benchmarks where available, highlights relevant coding considerations for open fixation of scaphoid fractures, and provides a compact reference for coding, billing, and clinical teams. Data not available in the input for specific ICD-10 pairings or associated taxonomies is noted as such.
Billing Code Overview
CPT code 25628 describes an open treatment of a scaphoid fracture. The procedure involves a surgical incision in the wrist to directly access the scaphoid bone and reduce the fracture, often with internal fixation such as wires or screws to stabilize the bone for healing. This code applies when the provider performs an open operative approach rather than percutaneous or closed management.
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Service Type: Open surgical fixation of scaphoid fracture
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Typical Site of Service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 28-year-old right-hand-dominant male falls from a bicycle onto an outstretched hand and presents to the emergency department with wrist pain, swelling, and snuffbox tenderness. Radiographs and dedicated scaphoid views demonstrate a displaced fracture of the scaphoid waist. After initial closed reduction attempts and immobilization in a thumb spica splint, the orthopedic hand surgeon schedules an open reduction and internal fixation of the scaphoid. In the operating room under regional block or general anesthesia, a dorsal or volar wrist incision is made to expose the scaphoid; reduction is achieved and internal fixation (headless compression screw or K-wires) is placed. Postoperative care includes immobilization in a short arm cast or splint, wound checks, x-ray follow-up to confirm hardware position and fracture healing, and hand therapy as indicated. Typical site of service is the hospital operating room or ambulatory surgery center. The service type is open operative repair of a scaphoid fracture (25628).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left wrist/scaphoid. |
RT |