Summary & Overview
CPT 25645: Open Fixation of Carpal Bone Fracture (Excluding Scaphoid)
CPT code 25645 represents open surgical treatment of a carpal bone fracture other than the scaphoid, typically involving incision of the wrist and internal fixation with wires or screws. This procedure is clinically important because wrist and carpal fractures are common injuries following falls or trauma and often require operative stabilization to restore function and prevent long-term disability. Nationally, the code is used across surgical settings and carries implications for facility and surgeon billing, utilization monitoring, and postoperative care planning.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service delivery for CPT code 25645, plus benchmarking details where available, common billing modifiers, and considerations for site-of-service variation. The publication covers typical resource use and payment considerations relevant to hospitals, ambulatory surgery centers, and orthopedic practices. It also highlights policy and coding points that affect coverage determinations and claims processing for open fixation of non-scaphoid carpal fractures.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 25645 describes an open treatment of a carpal bone fracture (other than scaphoid). The procedure involves a surgical incision at the wrist to expose the fractured carpal bone, with reduction and internal fixation as needed using devices such as wires or screws to stabilize the bone for healing.
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Service type: Open surgical fracture fixation of a carpal bone (excluding scaphoid)
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Typical site of service: Operative suite or ambulatory surgery center; inpatient setting when clinically indicated
Clinical & Coding Specifications
Clinical Context
A 42-year-old right-hand-dominant construction worker presents to the emergency department after falling from a ladder onto an outstretched hand. Imaging demonstrates a displaced fracture of the lunate (or other non-scaphoid carpal bone) with joint incongruity and instability. Nonoperative management is deemed insufficient because of displacement and instability. The patient is scheduled for an open reduction and internal fixation of the carpal fracture under regional block or general anesthesia. Preoperative workflow includes history and physical, informed consent, relevant imaging review (plain radiographs and often CT), and surgical planning for internal fixation using screws, plates, or Kirschner wires. Intraoperatively, a dorsal or volar wrist incision is made to expose the carpal fracture, fragments are anatomically reduced, and fixation devices are applied. The surgical team documents the specific bone treated, approach, implants used, estimated blood loss, tourniquet time (if applicable), and any intraoperative complications. Postoperative care includes immobilization in a splint or cast, pain control, instructions for elevation and wound care, and scheduled orthopedic follow-up for radiographic monitoring and possible hardware removal if indicated. Typical site of service: ambulatory surgery center or hospital outpatient surgery department; inpatient admission is possible for complications or polytrauma. Service type: open operative fixation of a carpal bone fracture (excluding scaphoid). Typical patient scenario: adult with displaced/unstable non-scaphoid carpal fracture after fall onto an outstretched hand requiring open reduction and internal fixation using screws/wires via wrist incision.
Coding Specifications
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