Summary & Overview
CPT 25695: Open Repair of Wrist Fracture
CPT code 25695 denotes an open surgical repair of fractures of the wrist bones performed through a skin incision. The code captures definitive operative management for displaced or complex wrist fractures commonly resulting from high-energy trauma. Nationally, this procedure represents a significant category of orthopedic trauma surgery with implications for surgical capacity, post-acute rehabilitation needs, and device utilization.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for operative wrist fracture repair, common sites of service where the procedure is delivered, and the operational considerations that affect coding and billing. The publication summarizes payer coverage patterns and benchmark elements where available, highlights coding and documentation focal points relevant to orthopedic surgeons and billing staff, and outlines the clinical scenarios that typically justify open repair versus closed or percutaneous approaches.
This content is intended for a national audience of clinicians, coding professionals, and health policy analysts seeking a concise reference on the procedural definition, service setting, and payer landscape associated with CPT code 25695. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 25695 describes open surgical repair of a fracture of the bones of the wrist performed through a skin incision. The procedure addresses fractures typically resulting from major trauma to the wrist and hand and involves direct visualization and fixation or repair of the bony structures.
Service type: Surgical — Open fracture repair / Orthopedic surgery
Typical site of service: Operating room or ambulatory surgery center, with perioperative care in hospital inpatient or outpatient surgical settings depending on injury severity and clinical needs.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presented to the emergency department after a high-energy fall from a ladder onto his outstretched hand. Examination revealed deformity, swelling, and point tenderness at the distal radius and radiocarpal area with neurovascularly intact digits. Plain radiographs demonstrated a displaced intra-articular distal radius fracture with metaphyseal comminution. After closed reduction attempts in the ED with poor alignment, the orthopedic hand surgeon scheduled operative open reduction and internal fixation. The patient underwent general anesthesia in the ambulatory surgical center; through a volar wrist incision the fracture fragments were reduced and fixed with a volar plate and screws. Postoperative care included immobilization in a splint, pain control, and early hand therapy referral.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Rarely appended; indicates no specific modifier applies |
51 | Multiple procedures | When distinct surgical procedures are performed at the same session in addition to the wrist fracture repair |