Percutaneous pin or wire fixation to stabilize a dislocated distal radioulnar joint without open incision

Verified May 8, 2026 · 6 sources ↓

Medicare: $522.72
Work RVU: 6.3
Global, days: 90
Region: Wrist

Drawn from CMSAAPCAAOSEmednyMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify the mechanism of injury (e.g., fall on outstretched hand, high-energy trauma) and acuity (acute vs. chronic dislocation)
Identify the injured side explicitly — left, right, or bilateral — in the operative note and on the claim
Document fluoroscopic confirmation of DRUJ alignment before and after pin placement, including number and configuration of pins/wires used
Record the percutaneous technique — note that no formal open arthrotomy was performed to justify the 25671 code vs. open alternatives
If a concurrent distal radius fracture procedure is performed, document each procedure's distinct work to support separate billing with modifier 59 or XS
Capture anesthesia type, patient positioning, and post-reduction stability assessment in the operative report

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25671 describes percutaneous skeletal fixation of a distal radioulnar joint (DRUJ) dislocation — the surgeon guides pins or K-wires through the skin to hold the radius and ulna in correct alignment at the wrist. No formal open arthrotomy is made; the approach is minimally invasive under fluoroscopic guidance. This code sits in the Fracture and/or Dislocation Procedures on the Forearm and Wrist subsection and carries a 90-day global period.

DRUJ dislocation most commonly results from a fall on an outstretched hand and can present as an isolated injury or in combination with a distal radius fracture. When a distal radius fracture is treated simultaneously (e.g., 25605 or 25606), review NCCI edits carefully — each procedure must be distinctly documented and modifier 59 or XS applied where appropriate. Do not confuse 25671 (DRUJ) with 25675 (closed treatment of distal radius/ulnar dislocation with manipulation) or 25676 (open treatment).

Billing 25671 in an ASC versus a hospital HOPD setting produces meaningfully different facility payment rates — see the Site of Service comparison table on this page. The 90-day global means any related E/M or procedure in the postoperative window requires modifier 24, 25, 78, or 79 to be separately reimbursable. A decision-for-surgery E/M billed the day of or day before needs modifier 57.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.3) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.65) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.3
Practice expense RVU	8.02
Malpractice RVU	1.33
Total RVU	15.65
Medicare national rate	$522.72
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$522.72
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25671 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code family — 25671 billed when operative note describes an open approach, which maps to a different code
Missing laterality modifier (LT or RT) required by Medicare and most commercial payers for unilateral wrist procedures
NCCI bundling denial when 25671 is billed same-session with a distal radius fracture code without a valid unbundling modifier (59 or XS) and supporting distinct documentation
Global period conflict — related E/M or procedure billed within the 90-day global without modifier 24, 78, or 79
ICD-10 diagnosis mismatch — dislocation diagnosis code (S63.01x series) not present or coded to wrong anatomical site

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 25671 and 25675?

25671 is percutaneous skeletal fixation — pins or wires are placed through the skin to hold the reduced DRUJ. CPT 25675 is closed treatment of a distal radius/ulnar dislocation with manipulation but without any fixation hardware. If you reduced the joint and placed percutaneous pins, 25671 is correct.

02Can I bill 25671 with a distal radius fracture code on the same day?

Yes, but you must document the distinct work for each procedure and append modifier 59 or XS to the secondary code to bypass the NCCI bundle. The operative note must support that both procedures were separately performed and medically necessary — a single-sentence mention of the DRUJ will not survive audit.

03Which laterality modifier is required?

Append LT or RT for unilateral procedures. Bilateral DRUJ fixation is exceptionally rare, but if performed, modifier 50 applies. Most payers require laterality on all unilateral extremity codes — missing it is a top front-end rejection reason.

04Does the 90-day global period apply to 25671?

Yes. The global is 090, meaning routine post-op visits, dressing changes, and pin removal within 90 days are bundled. Bill modifier 24 for unrelated E/M visits, modifier 78 for an unplanned return to the OR for a related complication, and modifier 79 for an unrelated surgical procedure during the global.

05When does modifier 22 apply to 25671?

Use modifier 22 when the procedure required substantially greater work than typical — for example, a chronic or locked dislocation requiring extensive manipulation, or an unusually complex pin configuration. Document the specific factors that increased complexity in the operative note; a generic statement of difficulty will not support the upcharge.

06If the decision for surgery was made during a same-day E/M, which modifier applies?

Append modifier 57 to the E/M code when the decision for this major surgery (90-day global) was made at that visit. This allows separate payment for the E/M within the preoperative global window. Modifier 25 is for minor procedures (10-day global) — do not use it here.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the percutaneous approach, fluoroscopic pin placement, DRUJ reduction confirmation, laterality, and any concurrent distal radius fracture work directly from dictation. That documentation prevents the two most common 25671 audit flags: an operative note that doesn't explicitly rule out open arthrotomy, and missing laterality that triggers an automatic payer rejection.

See how Mira captures CPT 25671 documentation