Open surgical repair of a trans-scaphoperilunar fracture-dislocation of the wrist, including internal fixation to restore carpal alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $691.40
Total RVUs: 20.7
Global, days: 90
Region: Wrist

Drawn from CMSNIHAbosAAPCFindacode

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 surgical approach by name (dorsal, volar, or combined) — notes that say 'standard approach' draw audit scrutiny
Document the pattern of injury: scaphoid fracture site, perilunate dislocation direction, and which carpal bones were displaced
Identify all fixation hardware used (K-wires, headless compression screws, plates) with size and number
Record intraoperative fluoroscopic confirmation of reduction and hardware position
Document neurovascular status pre- and post-reduction, including median nerve assessment given carpal tunnel proximity
If modifier 22 is appended, the operative note must explicitly describe what made the work substantially greater than typical — chronic dislocation, prior failed reduction, or severe comminution

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 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25685 covers open treatment of a trans-scaphoperilunar fracture-dislocation — a high-energy wrist injury involving fracture through the scaphoid combined with perilunar disruption. The surgeon opens the wrist through a dorsal, volar, or combined approach, reduces the dislocated carpal bones, and stabilizes the construct with internal fixation hardware (screws, K-wires, or plates). This is not a simple distal radius repair; the complexity of carpal realignment distinguishes it from codes like 25600–25609.

The 90-day global period governs all routine post-op management. Unrelated E/M visits during the global window require modifier 24. If you're also treating a concurrent distal radius fracture or ligamentous injury at the same session, modifier 51 applies to the secondary procedure, and documentation must justify each separately billable component.

Site of service matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison table. Most of these cases land in the OR given anesthesia requirements and implant needs, so confirm your facility designation before submitting.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.84
Practice expense RVU	8.77
Malpractice RVU	2.09
Total RVU	20.7
Medicare national rate	$691.40
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	$691.40
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 25685 get rejected.

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

Diagnosis code mismatch — ICD-10 must capture both the scaphoid fracture and the perilunar dislocation components; a single fracture code without the dislocation component is insufficient
Modifier 22 submitted without supporting documentation of increased complexity in the operative note
Bundling conflict when fluoroscopy is billed separately — fluoroscopic guidance used solely to confirm reduction is integral to 25685 and not separately reimbursable
Global period billing errors — post-op visits for routine wound care or hardware checks submitted without modifier 24 or 79 are denied as included in the 90-day global
Bilateral modifier 50 applied incorrectly — trans-scaphoperilunar fracture-dislocations are almost never bilateral, and payers flag this combination for review

Frequently asked questions

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

01How does 25685 differ from 25670 (open treatment of radiocarpal or intercarpal dislocation)?

25670 covers open dislocation repair without a concurrent scaphoid fracture. 25685 is specific to the trans-scaphoperilunar pattern — a scaphoid fracture combined with perilunar dislocation. If the scaphoid fracture is present, 25685 is the correct code, not 25670.

02Can I bill 25685 and 25645 together if I also fix a separate carpal bone fracture at the same session?

Potentially yes, but append modifier 59 to the additional carpal fracture code to signal a distinct procedure. Your operative note must document each fracture site and its independent treatment. NCCI edits may bundle them, so verify the pairing before submitting.

03Is modifier 22 defensible for a chronic trans-scaphoperilunar dislocation with AVN?

Yes, if the operative note documents the specific factors that increased work — avascular necrosis of the proximal scaphoid pole, scar tissue requiring extensive debridement, or need for bone grafting. Generic statements about complexity won't survive audit.

04What happens if the procedure is stopped after incision but before fixation is completed?

Use modifier 53 (discontinued procedure) only if cessation was due to a patient safety event during the procedure. If the procedure was reduced in scope by choice, modifier 52 applies instead. Document the reason explicitly in the operative note and anesthesia record.

05Does the 90-day global include carpal tunnel release if median nerve symptoms develop post-op?

If the carpal tunnel release is directly related to the original surgery (e.g., post-traumatic swelling or scarring from the original injury and repair), use modifier 78 — unplanned return for a related procedure. If it's a new, independent diagnosis unrelated to the original injury, use modifier 79.

06Can an assistant surgeon bill for 25685?

Yes. An assistant surgeon bills with modifier 80 (or AS for a PA/NP/CRNA first assist). CMS allows assistant surgeon billing for 25685 — confirm with the specific payer, as some commercial plans restrict assistant billing on wrist procedures.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the approach name, carpal bones involved, reduction method, fixation hardware with count and size, and intraoperative fluoroscopy findings directly from dictation. That prevents the two most common audit flags on 25685: an operative note that omits the specific dislocation pattern and a note that can't support modifier 22 when increased complexity is claimed.

See how Mira captures CPT 25685 documentation