Musculoskeletal CPT Coding: Fractures, Dislocations, and Trauma Repair
Fracture care architecture
CPT organizes fracture treatment by site and method: closed without manipulation, closed with manipulation, percutaneous, and open. With manipulation requires a documented reduction, not merely cast application. If the physician only applies a splint or cast, report the casting or splinting code (29000-29999) instead. Fracture care carries a 90-day global and includes the first cast or splint, routine follow-up, and hardware removal performed within the global. Later cast changes by the same physician are generally included; a cast applied by a different physician may be reportable.
Dislocations and associated trauma
Dislocation codes are also open versus closed, and some require anesthesia. Associated fractures may be coded separately when the note describes treatment of both. Open fractures may involve debridement codes 11010-11012; check current NCCI bundling before reporting. Traumatic wound repair, tendon and nerve repair, and foreign body removal follow their own site-specific rules.
Traps
- Assuming a closed reduction from the title when the body says no manipulation was needed.
- Reporting an E/M on the same day as fracture care without a significant, separately documented service.
- Missing a second fracture at a separate site; use the appropriate modifier when the payer allows.
- Confusing application of a cast with fracture care, since the fracture code already includes the first cast.
Rule of thumb: if the note does not describe manipulating the bone, do not use the with-manipulation code.
Worked example: The note documents closed reduction of a distal radius fracture and application of a short arm cast. Report 25605, not 25600 plus a casting code.