Open treatment of acute or chronic distal radioulnar joint dislocation, performed when closed methods have failed or the dislocation is irreducible.

Verified May 8, 2026 · 6 sources ↓

Medicare: $595.20
Work RVU: 8.08
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFastrvuMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether dislocation is acute or chronic — the code covers both, but the operative note must state duration and mechanism
Document why open treatment was chosen: failed closed reduction attempt, irreducibility, chronic fibrosis, or associated injury requiring direct repair
Identify which joint was treated — distal radioulnar joint — not just 'wrist dislocation'; vague location language invites audit flags
Record direction of dislocation (dorsal or volar ulnar head) and intraoperative confirmation of reduction
Note any concurrent procedures (e.g., TFCC repair, ulnar shortening) with distinct operative descriptions to support separate billing
Include pre-op imaging (X-ray, CT) in the record confirming DRUJ instability or dislocation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25676 covers open surgical treatment of a distal radioulnar joint (DRUJ) dislocation — either acute or chronic. The DRUJ connects the distal radius and ulna at the wrist; dislocation disrupts forearm rotation and grip. Open treatment is indicated when closed reduction fails, when the dislocation is chronic and fibrous tissue has blocked reduction, or when associated injuries require direct visualization.

The 90-day global period bundles the day-before visit, the surgery itself, and all routine post-op care through day 90. Any E/M service on the day of the decision to operate carries modifier 57. Unrelated procedures in the global window need modifier 79; related return trips to the OR use modifier 78. For fractures of the distal radius or ulna treated on the same day, check NCCI edits before appending modifier 59 or 51 — not all combinations are cleanly separable.

Site of service matters: HOPD and ASC payments differ substantially (see the site-of-service comparison table on this page). Bilateral DRUJ dislocation is rare but possible; when it occurs, bill a single line with modifier 50 on the physician claim. ASCs must use separate LT and RT lines per CMS bilateral billing rules.

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 (8.08) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.82) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.08
Practice expense RVU	8.13
Malpractice RVU	1.61
Total RVU	17.82
Medicare national rate	$595.20
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	$595.20
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25676 get rejected.

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

Diagnosis code doesn't specify DRUJ — using a generic wrist dislocation ICD-10 without laterality triggers mismatch edits
Missing documentation of failed closed reduction when open treatment is the index procedure, leading to medical necessity denials
Concurrent procedures (e.g., 25608, 25652) bundled without appropriate modifier support or distinct operative narrative
Presurgical E/M billed without modifier 57 during the 90-day global period of a prior related surgery
Laterality modifier absent — payers routinely reject claims for extremity procedures that lack LT or RT

Frequently asked questions

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

01Does 25676 cover both acute and chronic DRUJ dislocations?

Yes. The code explicitly includes both acute and chronic dislocations. Document the duration and mechanism clearly — chronic cases often require more extensive soft-tissue work, which may support modifier 22 if the additional work is substantial and well-documented.

02What modifier goes on the presurgical E/M for this procedure?

Modifier 57. CPT 25676 carries a 90-day global period, which makes it a major surgery. Any E/M on the day the decision to operate is made needs modifier 57 — not modifier 25, which is reserved for 0- or 10-day global procedures.

03Can 25676 be billed with distal radius fracture codes like 25608 on the same day?

Sometimes, but check NCCI edits first. When the DRUJ dislocation and a distal radius fracture are clearly separate injuries addressed by distinct operative steps, modifier 59 may apply. The operative note must describe each procedure independently — a combined or vague note will not support separate billing.

04How do you bill bilateral DRUJ dislocations?

On a physician claim, bill one line with modifier 50. On an ASC claim, use two lines — one with modifier LT and one with RT — each with one unit of service. This follows CMS bilateral billing rules per the NCCI Policy Manual.

05Is fluoroscopy separately billable when used during open DRUJ reduction?

No. Fluoroscopic guidance used intraoperatively to confirm reduction is considered integral to the open procedure and is not separately reportable under NCCI policy. Don't add a fluoroscopy code unless it was performed for a distinct, separately documented purpose.

06What ICD-10 codes pair with 25676?

Use DRUJ dislocation codes from the S63 category with the appropriate laterality and episode-of-care character (A for initial, D for subsequent). Chronic instability may code differently — confirm the specific ICD-10 with your MAC's LCD and verify laterality is present or the claim will likely reject.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the direction of dislocation (dorsal vs. volar), confirmation that closed reduction was attempted or contraindicated, the operative approach and reduction technique, and any concurrent soft-tissue or bony procedures with their distinct steps. That detail prevents the two most common denials: a medical necessity flag for jumping straight to open treatment, and a bundling rejection when same-day codes lack separate procedural documentation.

See how Mira captures CPT 25676 documentation