Glossary · Clinical

Closed reduction

Closed reduction is the non-surgical realignment of a fractured or dislocated bone in which the fracture site is never opened, incised, or directly visualized. It may be performed without manipulation, with manual manipulation, with skeletal traction, or with skin traction.

Verified May 8, 2026 · 7 sources ↓

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Definition

Source · Editorial summary grounded in 7 cited references ↓

Closed reduction describes any fracture or dislocation treatment in which the injury site remains intact—no surgical incision is made and the bone ends are never exposed to the outside environment. The treating clinician achieves alignment through external forces: manual manipulation, skeletal traction (wire, pin, or screw through bone), or skin traction (straps or devices applied to skin only). Importantly, CPT defines treatment type by what the provider does, not by the fracture type itself. A compound (open) fracture wound does not automatically mean open treatment was performed; an emergency physician managing a compound fracture without entering the fracture site is still providing closed treatment.

Closed reduction stands in contrast to open reduction, which requires a surgical incision to expose the fracture for direct visualization, and to percutaneous skeletal fixation, which involves pin placement without direct fracture exposure. Casting, splinting, or strapping applied solely for temporary patient comfort—without the intent to provide definitive treatment—does not meet CPT's threshold for closed treatment and should not trigger a fracture care code.

For coding purposes, closed treatment encompasses three distinct service levels: without manipulation (e.g., cast or splint as definitive care), with manipulation, and with or without skeletal/skin traction. Each level has its own CPT code family, and selecting the wrong level is one of the most common sources of audit findings and claim denials in orthopedic and emergency medicine practices.

Why it matters

Correctly distinguishing closed reduction—and its sub-type (with vs. without manipulation)—directly determines which CPT code is reported, the applicable 90-day global surgical package, what services are bundled versus separately billable, and whether modifier 54 or 55 must be appended when post-operative care is split between providers. Billing an E/M code instead of a fracture care code (or vice versa) changes reimbursement, changes what can be billed separately (casting supplies, X-rays, DME), and can trigger NCCI edits or post-payment audits. Selecting the wrong sub-type—billing a with-manipulation code when only immobilization was applied—constitutes upcoding and creates significant compliance risk.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Coding closed reduction 'with manipulation' when only a cast or splint was applied for definitive immobilization without any manual realignment attempt.
Assigning an open-treatment CPT code because the fracture itself was open (compound), when the provider never surgically opened the fracture site.
Reporting a fracture care CPT code (with its 90-day global package) for temporary stabilization only—such as a splint placed in the ED solely for patient comfort before hand-off—when an E/M code is correct.
Failing to append modifier 54 (surgical care only) when the treating provider performs closed reduction but will not provide the 90-day post-operative follow-up, exposing the claim to global-period denial for subsequent visits.
Separately billing cast or splint application when a fracture care CPT code was already reported, since the initial casting and strapping are bundled into the global package.
Confusing 'closed fracture' (a type of injury) with 'closed treatment' (a type of procedure); these are independent descriptors and do not correlate with each other in CPT.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Modifiers

57 Decision for surgery 76 Repeat procedure same physician 25 Significant separately identifiable E/M

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does 'closed fracture' mean the same thing as 'closed treatment'?

No. 'Closed fracture' describes the injury—skin over the fracture is intact. 'Closed treatment' describes the procedure—the fracture site was not surgically opened. An open (compound) fracture can be treated with closed techniques if the surgeon never incises the fracture site, and a closed fracture may ultimately require open surgical treatment.

02What is included in the 90-day global package when a closed reduction CPT code is billed?

The global package bundles the initial cast, splint, or strapping; all routine post-operative follow-up visits within 90 days; and re-reduction by the same provider if needed. X-rays, durable medical equipment, and casting or splinting supplies are excluded from the bundle and may be billed separately.

03When should the provider bill an E/M code instead of a fracture care code?

Report an E/M code—not a fracture care code—when no definitive treatment is performed. Examples include undisplaced fifth metatarsal fractures managed with observation, minimally displaced pelvic fractures, and situations where a splint is applied purely to stabilize the patient for transfer or comfort rather than as definitive fracture management.

04What happens if the treating provider will not follow the patient through the 90-day global period?

The treating provider appends modifier 54 (surgical care only) to the fracture care code. The provider who assumes post-operative follow-up appends modifier 55 to the same code and documents the date on which care was transferred. Both providers receive a prorated share of the global fee.

05Can the same provider bill for re-reduction of the same fracture?

Yes, but modifier 76 (repeat procedure by the same provider) must be appended to the fracture care code to indicate that a subsequent reduction was necessary because satisfactory alignment was not maintained after the initial reduction.

06Is closed treatment of a nasal bone fracture without manipulation still a separately billable fracture care service?

No. CPT deleted the code for closed treatment of nasal bone fracture without manipulation (formerly 21310) effective 2022. When no manipulation or stabilization is performed, the correct approach is to report an appropriate E/M code.

Sources & references

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

Mira AI Scribe

When Mira detects documentation of fracture or dislocation management, it evaluates whether the clinical note supports closed treatment and, if so, which sub-type applies. • If the note describes manipulation—manual force applied to achieve alignment—Mira will suggest the 'with manipulation' CPT variant for the relevant anatomic site. • If the note describes only cast, splint, or strapping as definitive immobilization with no manipulation language, Mira will suggest the 'without manipulation' variant and flag that an E/M code may be appropriate instead if the service was temporary stabilization only. • If the treating provider documents that post-operative follow-up will be provided by a different clinician, Mira will prompt attachment of modifier 54 to the fracture care code and modifier 55 for the receiving provider. • Mira will alert the coder when the note contains language indicating a compound (open) fracture but the procedure description does not document surgical incision or direct visualization, confirming that a closed-treatment code—not an open-reduction code—remains correct. • If the note describes casting or splinting described explicitly as temporary comfort measure pending specialist referral, Mira will suppress the fracture care code suggestion and recommend an E/M code with separately billable cast/splint codes as appropriate. • Mira will flag any note pairing a 90-day global fracture care CPT code with a same-date E/M code from the same provider unless modifier 25 is documented with a clearly separate, significant E/M service.

See Mira's approach

Related terms

External fixation Clinical

External fixation is a surgical stabilization technique in which pins or wires are anchored into bone and connected to a rigid frame that remains entirely outside the skin, allowing fracture alignment and wound access without an implant buried beneath soft tissue.