Utilization of Billing Codes for Complexity in Open Reduction and Internal Fixation of Distal Radius Fractures.
- 1The University of Texas Southwestern Medical Center, Dallas, USA.
- 2Program on Policy Evaluation and Learning, Dallas, TX, USA.
- 3The University of Texas Southwestern School of Medicine, Dallas, USA.
Abstract
Background
Reimbursement has not matched the additional time, effort, and risk required for complex surgeries. Although modifier 22 billing codes have been created to address this gap, their impact has been muted by high denial rates. There is limited information about modifier 22 use in open reduction and internal fixation (ORIF) of distal radius fracture.Methods
We used 2010-2024 national claims to examine use of and reimbursement for modifier 22 in ORIF of distal radius fracture. Propensity score-matched multivariable generalized linear models were used to examine associations between patient complexity, fracture complexity, and other characteristics and use and reimbursement for modifier 22 in ORIF of the distal radius fracture.Results
In a propensity score-matched cohort of 2694 patients, 17% had a modifier 22, and modifier 22 was the most used with Current Procedural Terminology (CPT) code 25609, a more complex 3+ part intra-articular fracture (78%). Modifier 22 use was similar among patients with and without comorbidities. The median total payments for ORIF of a distal radius fracture with modifier 22 was $15 788 (interquartile range, 8676−22 357). Procedures with modifier 22 were associated with higher total payments ($2033, 95% CI: 2224−2952), and there were small differences based on clinical complexity, with CPT 25607 having lower total payments compared with CPT 25609.Conclusion
Modifier 22 use was low and did not vary by clinical complexity but did vary based on fracture complexity. More work is needed to elucidate barriers and facilitators to use, and its role in reflecting time and effort required for complex surgeries.
Related
- Arthroscopic versus open reduction and internal fixation for tibial plateau fractures: a meta-analysis
- Association of bone mineral-reducing medications with two-year complications following open reduction and internal fixation of ankle fractures: a propensity score-matched analysis
- Long-Term Complications and Secondary Procedures After Open Reduction and Internal Fixation of Ankle Fractures: A Descriptive Epidemiologic Study of Over 50,000 Patients.
- Double Tension Band Wiring Versus Plating for Internal Fixation of Distal Humeral Fractures
- Arthroplasty versus internal fixation for displaced femoral neck fractures in older patients with dementia: a target trial emulation study
BibTeX
@article{billig2026utilization,
title = {{Utilization of Billing Codes for Complexity in Open Reduction and Internal Fixation of Distal Radius Fractures.}},
author = {Jessica I Billig and Yixin Tang and Jennifer R Cardin and Joseph H Joo and Victoria Peters and Joshua M Liao},
journal = {Hand (New York, N.Y.)},
year = {2026},
month = oct,
doi = {10.1177/15589447261495679},
url = {https://europepmc.org/article/MED/42953903},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Utilization of Billing Codes for Complexity in Open Reduction and Internal Fixation of Distal Radius Fractures.
AU - Jessica I Billig
AU - Yixin Tang
AU - Jennifer R Cardin
AU - Joseph H Joo
AU - Victoria Peters
AU - Joshua M Liao
PY - 2026
DA - 2026/10/29
JO - Hand (New York, N.Y.)
DO - 10.1177/15589447261495679
UR - https://europepmc.org/article/MED/42953903
AB - Background Reimbursement has not matched the additional time, effort, and risk required for complex surgeries. Although modifier 22 billing codes have been created to address this gap, their impact has been muted by high denial rates. There is limited information about modifier 22 use in open reduction and internal fixation (ORIF) of distal radius fracture.Methods We used 2010-2024 national claims to examine use of and reimbursement for modifier 22 in ORIF of distal radius fracture. Propensity score-matched multivariable generalized linear models were used to examine associations between patient complexity, fracture complexity, and other characteristics and use and reimbursement for modifier 22 in ORIF of the distal radius fracture.Results In a propensity score-matched cohort of 2694 patients, 17% had a modifier 22, and modifier 22 was the most used with Current Procedural Terminology (CPT) code 25609, a more complex 3+ part intra-articular fracture (78%). Modifier 22 use was similar among patients with and without comorbidities. The median total payments for ORIF of a distal radius fracture with modifier 22 was $15 788 (interquartile range, 8676−22 357). Procedures with modifier 22 were associated with higher total payments ($2033, 95% CI: 2224−2952), and there were small differences based on clinical complexity, with CPT 25607 having lower total payments compared with CPT 25609.Conclusion Modifier 22 use was low and did not vary by clinical complexity but did vary based on fracture complexity. More work is needed to elucidate barriers and facilitators to use, and its role in reflecting time and effort required for complex surgeries.
SN - 1558-9447
SN - 1558-9455
ER -