Glossary · Anatomy

Scaphoid

The scaphoid is the largest bone of the proximal carpal row, situated on the radial side of the wrist between the radius and the distal carpal bones. It is the most frequently fractured carpal bone and is notorious for a tenuous blood supply that predisposes fractures to nonunion and avascular necrosis.

Verified May 8, 2026 · 7 sources ↓

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Definition

Source · Editorial summary grounded in 7 cited references ↓

The scaphoid (also called the navicular bone of the wrist) occupies a bridging position across both rows of the carpus. Its proximal pole articulates with the radius; its distal pole contacts the trapezium and trapezoid. This dual-row span means forces transmitted through the wrist concentrate heavily on the scaphoid waist, explaining why waist fractures account for roughly 70–80% of all scaphoid injuries.

The bone's blood supply enters almost exclusively through the distal pole via branches of the radial artery, perfusing the waist and proximal pole in a retrograde direction. A fracture anywhere along the waist or proximal pole can therefore interrupt perfusion to the proximal fragment, creating meaningful risk of delayed union, nonunion, or avascular necrosis — especially when diagnosis or treatment is delayed. Plain radiographs miss a significant proportion of acute scaphoid fractures; CT or MRI is often required to confirm the diagnosis and characterize displacement.

Anatomically, the scaphoid is divided into three regions for clinical and coding purposes: the proximal third, the middle third (waist), and the distal third (including the tubercle). ICD-10-CM and CPT code selection both require coders to reflect this regional distinction, the presence or absence of displacement, laterality, and the episode of care — making precise anatomical knowledge directly relevant to billing accuracy.

Why it matters

Failing to document the specific fracture location within the scaphoid — proximal, middle, or distal third — forces a coder to default to an unspecified code, which payers routinely flag for medical necessity review or outright denial. Similarly, missing displacement status or laterality in the clinical note creates the same specificity gap. On the procedure side, the distinction between closed treatment without manipulation (CPT 25622), closed treatment with manipulation (CPT 25624), and open or percutaneous fixation (CPT 25628) can produce substantial reimbursement differences; the operative note must clearly document what was actually performed to defend the code chosen. Nonunion repairs with bone grafting (CPT 25440) are subject to NCCI bundling scrutiny, so thorough documentation of the graft harvest and fixation method is essential to avoid claim downcoding.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Assigning an unspecified scaphoid fracture code (e.g., S62.001_) when the clinical note identifies a waist or proximal-pole fracture — the middle-third and proximal-third codes carry more clinical weight and satisfy payer specificity requirements.
Omitting laterality in the ICD-10-CM code: scaphoid fracture codes require right, left, or unspecified wrist designation; missing this detail is a leading cause of orthopedic claim rejection.
Confusing the seventh-character encounter qualifier — initial (A), subsequent with routine healing (D), subsequent with delayed healing (G), subsequent with nonunion (K), or sequela (S) — each maps to different downstream DRG and APC groupings.
Billing CPT 25628 (open treatment or percutaneous fixation) without operative documentation that explicitly describes the approach and fixation hardware, leaving the claim vulnerable to audit or downcoding to the closed-treatment code.
Failing to separately document radial styloidectomy when performed alongside scaphoid nonunion repair (CPT 25440); the CPT descriptor includes it when performed, so reporting it as an add-on is an NCCI bundling error.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Modifiers

LT Left side RT Right side 59 Distinct procedural service XS Separate structure

Frequently asked questions

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

01Why does the scaphoid fracture so much more often than other carpal bones?

Its position bridging both carpal rows concentrates compressive and shear forces at the waist during a fall on an outstretched hand, making it the anatomical weak point of the carpus.

02What is the difference between the scaphoid and the navicular in coding?

They are the same bone. ICD-10-CM uses 'navicular' as a bracketed synonym in its fracture descriptors (e.g., 'fracture of navicular [scaphoid] bone of wrist'), so coders should recognize both terms as interchangeable when selecting diagnosis codes.

03When should a coder use CPT 25624 versus CPT 25628 for a scaphoid fracture?

CPT 25624 applies to closed treatment with manipulation — no skin incision and no internal fixation. CPT 25628 applies when the surgeon makes an incision or places a percutaneous pin or screw for fixation. The operative or procedure note must clearly state the approach and any hardware used to justify 25628.

04How does AVN of the scaphoid affect coding?

Avascular necrosis is coded separately under the M87 category in ICD-10-CM and should be reported as an additional diagnosis when documented. It also signals that a nonunion repair code (CPT 25440) — rather than a standard fracture treatment code — may be appropriate, since AVN commonly accompanies chronic nonunion.

05Does imaging guidance during percutaneous scaphoid fixation need a separate CPT code?

Not always. Per CMS NCCI policy, when a CPT code's descriptor or CMS instruction specifies that fluoroscopic guidance is integral to the procedure, a separate radiologic guidance code cannot be billed. Coders should verify the specific CPT descriptor and any applicable NCCI edits before reporting imaging guidance separately.

Sources & references

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

Related terms

Percutaneous fixation Clinical

Percutaneous fixation is a minimally invasive technique in which pins, screws, or wires are passed through intact skin and into bone to stabilize a fracture—without surgically opening or directly visualizing the fracture site, typically guided by fluoroscopy or other real-time imaging.