Assign Fracture And Orthopedic Codes - Certified Professional Coder CPC

1. A patient treated for a femur fracture by one physician is seen by a second physician who applies a long-leg walking cast. Which CPT® code covers application of a long-leg walking cast?
   Answer: 29355 CPT® 29355 covers application of a long-leg cast (thigh to toes), walking. When a provider who did not perform the fracture treatment applies the cast, the cast application code is separately reportable. Code 29358 covers a non-walking long-leg cast; 29365 covers a long-leg cylinder cast; 29405 covers a short-leg cast. The walking designation and cast length determine the specific cast application code.
2. A surgeon performs an arthroscopic anterior cruciate ligament (ACL) reconstruction using a patellar tendon graft. Which CPT® code covers arthroscopic ACL repair or reconstruction?
   Answer: 29888 CPT® 29888 covers arthroscopy, knee, surgical, with anterior cruciate ligament (ACL) repair/augmentation or reconstruction. Code 29889 covers posterior cruciate ligament (PCL) repair; 29880 covers meniscectomy (both menisci); 29876 covers synovectomy. ACL reconstruction is specifically assigned 29888, with PCL reconstruction coded separately as 29889.
3. A surgeon performs a total shoulder arthroplasty replacing both the humeral head and the glenoid surface. Which CPT® code covers total shoulder arthroplasty?
   Answer: 23472 CPT® 23472 covers total shoulder arthroplasty — replacement of both the humeral and glenoid components. Code 23470 covers hemiarthroplasty (humeral head prosthesis only); 23480 covers osteotomy of the clavicle; 23400 covers scapulothoracic fusion. When both prosthetic components are implanted, 23472 is used to distinguish total shoulder replacement from hemiarthroplasty.
4. A physician performs closed reduction (manipulation) of a Colles' fracture (distal radius) and applies a splint. Which CPT® code covers closed treatment of a distal radial fracture with manipulation?
   Answer: 25605 CPT® 25605 covers closed treatment of distal radial fracture (e.g., Colles or Smith type) with manipulation. Code 25600 covers closed treatment without manipulation; 25607 covers open treatment of extra-articular distal radial fracture; 25609 covers open treatment of intra-articular distal radial fracture. Closed manipulation (no surgical incision) is the defining feature, making 25605 the correct code for a Colles' fracture with reduction.
5. A physician inserts a skeletal traction pin into the distal femur for temporary stabilization of a femur fracture. Which CPT® code covers insertion of a skeletal traction pin?
   Answer: 20650 CPT® 20650 covers insertion of wire or pin with application of skeletal traction, including removal. Code 20690 covers uniplanar external fixator application; 20692 covers multiplanar external fixator; 20900 covers minor bone graft. Skeletal traction pin insertion — where a pin is driven through bone to apply longitudinal traction — is specifically reported with 20650, not an external fixation code.
6. A patient's tibia fracture healed, but the bone united in a significantly angulated position. At a subsequent encounter, the physician documents "malunion." Which ICD-10-CM 7th character designates a subsequent encounter for fracture with malunion?
   Answer: P ICD-10-CM 7th character 'P' designates a subsequent encounter for fracture with malunion — the fracture healed but in an abnormal or angulated position. Character 'G' designates delayed healing; 'D' designates routine subsequent encounter (healing progressing normally); 'M' designates subsequent encounter for open fracture type I or II with nonunion. For a closed fracture that has healed in malposition, 'P' is the correct 7th character. Malunion (P) and nonunion (K for closed fractures) are frequently tested distinctions in ICD-10-CM fracture coding.
7. A surgeon performs a lumbar microdiscectomy (laminotomy with excision of herniated disc) at L4-L5. Which CPT® code covers laminotomy with decompression and disc excision in the lumbar region?
   Answer: 63030 CPT® 63030 covers laminotomy with decompression of nerve roots, including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, 1 interspace, lumbar. Code 63000 covers cervical laminectomy for exploration; 63047 covers lumbar laminectomy with facetectomy and foraminotomy; 63012 covers cervical facetectomy. For a standard lumbar microdiscectomy, 63030 is the most commonly used code.
8. A surgeon performs open treatment of a displaced femoral neck fracture with internal fixation using cancellous lag screws. Which CPT® code covers open treatment of a femoral neck fracture with internal fixation?
   Answer: 27236 CPT® 27236 covers open treatment of femoral neck fracture with internal fixation or prosthetic replacement. Code 27230 covers closed treatment without manipulation; 27232 covers closed treatment with manipulation; 27240 covers treatment of intertrochanteric fracture. Open surgical fixation of the femoral neck — as opposed to closed manipulation — is specifically reported with 27236.
9. A surgeon performs an open carpal tunnel release — division of the transverse carpal ligament through a palmar incision. Which CPT® code covers open carpal tunnel release?
   Answer: 64721 CPT® 64721 covers neuroplasty and/or transposition of the median nerve at the carpal tunnel — the standard open carpal tunnel release. Code 64719 covers ulnar nerve neuroplasty at the wrist; 29848 covers endoscopic carpal tunnel release; 25447 covers carpal joint arthroplasty. Open and endoscopic carpal tunnel releases are separately coded — 64721 for open, 29848 for endoscopic.
10. A surgeon performs open reduction and internal fixation of a displaced distal radial extra-articular fracture. Which CPT® code covers open treatment of a distal radial extra-articular fracture with internal fixation?
    Answer: 25607 CPT® 25607 covers open treatment of distal radial extra-articular fracture with internal fixation. Code 25605 covers closed treatment with manipulation; 25600 covers closed treatment without manipulation; 25609 covers open treatment of an intra-articular distal radial fracture. The distinction between extra-articular and intra-articular involvement, combined with open vs. closed treatment, drives code selection within the distal radius fracture range.
11. A patient undergoes a right total hip arthroplasty for osteoarthritis. Which ICD-10-CM code correctly identifies primary osteoarthritis of the right hip?
    Answer: M16.11 ICD-10-CM M16.11 covers primary osteoarthritis of the right hip. Code M16.0 covers bilateral primary hip osteoarthritis; M16.9 covers unspecified osteoarthritis of the hip; M16.12 covers primary osteoarthritis of the left hip. When the surgery is unilateral on the right, M16.11 captures the required laterality specificity. Reporting M16.9 when laterality is documented constitutes incomplete coding.
12. A physician treats a nondisplaced clavicle fracture with a figure-of-eight splint. No reduction is required. Which CPT® code covers closed treatment of a clavicular fracture without manipulation?
    Answer: 23500 CPT® 23500 covers closed treatment of clavicular fracture without manipulation. Code 23505 covers closed treatment with manipulation; 23515 covers open treatment with internal fixation; 23520 covers closed treatment of sternoclavicular dislocation without manipulation. The absence of manipulation is the key clinical and coding differentiator for this nondisplaced fracture.
13. A surgeon performs a total knee arthroplasty replacing the tibial and femoral components. Which CPT® code covers total knee replacement?
    Answer: 27447 CPT® 27447 covers total knee arthroplasty, knee, tibial and femoral components with or without patellar resurfacing. Code 27443 covers arthroplasty with patellar resurfacing only; 27440 covers patellectomy; 27486 covers revision of total knee arthroplasty. Total knee replacement is specifically designated 27447, distinguishing it from partial procedures and revisions.
14. A surgeon performs a single-level anterior cervical discectomy and fusion (ACDF) at C5-C6 with interbody cage placement. Which CPT® code covers anterior cervical interbody fusion with discectomy?
    Answer: 22551 CPT® 22551 covers arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy, and decompression, cervical below C2. Code 22552 is the add-on for each additional interspace; 22554 covers anterior interbody fusion without discectomy; 22556 covers anterior thoracic interbody fusion. Single-level ACDF with discectomy at C5-C6 is reported with 22551.
15. A surgeon performs a primary open repair of an acute Achilles tendon rupture with direct end-to-end suture. Which CPT® code covers primary repair of a ruptured Achilles tendon?
    Answer: 27650 CPT® 27650 covers repair, primary, open or percutaneous, ruptured Achilles tendon. Code 27652 covers Achilles repair with graft (augmented repair); 27654 covers repair of neglected or chronic Achilles rupture; 27680 covers tenolysis of the Achilles tendon. For an acute primary repair without graft, 27650 is the correct code, distinguishing it from augmented or delayed repairs.
16. A physician applies a short-leg walking cast as part of the initial treatment of a stable ankle fracture. How is the cast application reported?
    Answer: It is included in the fracture treatment code and not separately reported CPT® guidelines specify that when a cast is applied by the treating physician as part of the initial fracture treatment, the cast application is bundled into the fracture treatment code and is not separately reportable. Cast application codes (29000–29799) are only reported separately when applied by a provider who did not perform the fracture treatment, or at a subsequent visit when casting is the only service rendered.
17. A surgeon performs arthroscopic partial meniscectomy of the lateral meniscus only of the right knee. Which CPT® code covers arthroscopy with meniscectomy of a single meniscus?
    Answer: 29881 CPT® 29881 covers arthroscopy, knee, surgical, with meniscectomy (medial or lateral including any meniscal shaving). Code 29870 covers diagnostic knee arthroscopy; 29880 covers meniscectomy of both medial and lateral menisci; 29874 covers removal of loose body or foreign body. For a single-meniscus (lateral or medial) meniscectomy, 29881 is reported. When both menisci are resected, 29880 is used.
18. A surgeon performs a posterior spinal fusion and harvests autologous iliac crest bone graft through a separate incision. Is the bone graft harvest separately reportable?
    Answer: Yes — iliac crest harvest through a separate incision is separately reportable using an add-on code Autologous iliac crest bone graft harvesting through a separate incision is separately reportable using CPT® add-on code 20937 (autograft, morselized) or 20938 (structural graft). These are reported in addition to the primary fusion code. Grafts harvested from the primary wound without a separate incision are not separately reportable. The separate incision justifies the additional code.
19. A surgeon performs intramedullary nailing with interlocking screws for a displaced femoral shaft fracture. Which CPT® code covers open treatment of a femoral shaft fracture with intramedullary fixation?
    Answer: 27506 CPT® 27506 covers open treatment of femoral shaft fracture, with or without external fixation, using any type of implant including intramedullary nail with interlocking screws. Code 27507 covers open treatment with plate(s) and screws only, without an intramedullary device; 27510 covers closed treatment with manipulation; 27514 covers ORIF of the distal femur. For intramedullary nailing of a femoral shaft fracture, 27506 is the correct code.
20. A physician performs a closed reduction of a glenohumeral dislocation in the emergency department without general anesthesia. Which CPT® code covers closed treatment of shoulder dislocation with manipulation, without anesthesia?
    Answer: 23650 CPT® 23650 covers closed treatment of shoulder dislocation with manipulation, without anesthesia. Code 23655 covers the same procedure requiring anesthesia; 23600 covers closed treatment of proximal humeral fracture without manipulation; 23615 covers open treatment of proximal humeral fracture. When a shoulder dislocation is reduced with manipulation and no anesthesia is required, 23650 is the correct code.

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