ICD code S52.092Q – Other fracture of upper end of left ulna

Key takeaways

ICD-10 code S52.092Q covers a subsequent encounter for another fracture of the upper end of the left ulna, open type I or II, with malunion.

The code is billable and specific. It is valid for fiscal year 2026, effective October 1, 2025, and it is exempt from present-on-admission reporting.

The 7th character Q carries three facts at once. It marks a subsequent encounter, an original open wound graded type I or II, and a malunion.

Character G is not the malunion character. On this code G means a closed fracture with delayed healing, and that mix-up is a frequent denial trigger.

Practice management software like Pabau checks ICD-10-CM detail before submission and connects to Claim.MD, so fracture claims leave the practice complete.

ICD-10 code S52.092Q: Quick reference

ICD-10 code S52.092Q is a billable, specific ICD-10-CM diagnosis code valid for the 2026 fiscal year. It took effect on October 1, 2025, per the CMS ICD-10-CM code updates.

What does ICD-10 code S52.092Q mean? Full code breakdown

Every segment of S52.092Q carries clinical meaning. Misreading any one character produces a different code, and that code reflects a different encounter type, fracture site, or healing outcome.

The term “other fracture” in S52.09 is an ICD-10-CM NEC designation, short for not elsewhere classified. It covers proximal ulna fractures that the more specific subcategories do not name. A torus fracture codes to S52.01x. An olecranon process fracture codes to S52.02x without intraarticular extension, or S52.03x with it. A coronoid process fracture codes to S52.04x. Monteggia’s fracture of the ulna is not part of this group at all. It has its own code, S52.27, with a 7th character of its own. The laterality digits are S52.271 for the right side, S52.272 for the left, and S52.279 when the side is undocumented.

Code classification and hierarchy

S52.092Q sits at the end of a five-level chain. Knowing each parent level matters when you search the ICD-10-CM index, or when a payer asks for a less specific code for grouping. Verify the full hierarchy against the CDC/NCHS ICD-10-CM web tool.

• S52 – Fracture of forearm
• S52.0 – Fracture of upper end of ulna
• S52.09 – Other fracture of upper end of ulna
• S52.092 – Other fracture of upper end of left ulna (base code requiring a 7th character)
• S52.092Q – Other fracture of upper end of left ulna, subsequent encounter for open fracture type I or II with malunion (billable and specific)

S52.092 is not billable on its own. It needs a valid 7th character extension to reach billable specificity. Submitted without that character, the claim comes back as incomplete.

Understanding ICD-10-CM 7th character fracture coding

The 7th character system governs every fracture code in the S52 family. For forearm fractures, ICD-10-CM uses an extended set of 16 characters that combine encounter type, open fracture grade, and healing status. Read the table in three columns rather than as a single alphabetical run, because the letters cycle through wound type inside each healing outcome.

Q applies only when both conditions hold. The original fracture was documented as open type I or II, and the current encounter shows the bone healed in a malunited position. Both have to be confirmed in the clinical record. The grid below reduces that 16-row list to the two questions a coder actually answers.

Malunion vs nonunion: The critical coding distinction

Malunion means the fracture has healed, but in a suboptimal or angulated position. Nonunion means healing has failed, with no bridging callus forming across the fracture site. The clinical record has to support whichever one the coder selects.

Open fracture classification and Gustilo-Anderson types

ICD-10-CM open fracture coding follows the Gustilo-Anderson classification, which orthopedic surgeons apply at debridement to grade wound contamination and soft tissue damage. That grade decides the 7th character at the initial encounter, and it carries forward to every subsequent encounter code for the same injury.

Types I and II share one pair of characters, B for the initial encounter and Q for a subsequent encounter with malunion. Types IIIA through IIIC share a separate pair, C and R. S52.092Q therefore applies only to fractures originally graded Gustilo type I or II.

Related ICD-10 codes for S52.092Q

Coders working with S52.092Q regularly need sibling codes for the same fracture at a different encounter stage, laterality, or healing outcome. These are the most clinically relevant codes in the S52.092 family.

The Q versus M distinction is the most audit-sensitive comparison in this family, because both describe the same open wound grade at a follow-up visit. Radiology reports settle it. Callus with angulation supports Q, and a persistent fracture line with no bridging callus supports M.

Documentation requirements before you assign the code

Six documentation elements have to be stated clearly in the record before S52.092Q can be assigned. Miss one and the coder cannot justify the code, which forces a query back to the treating provider. Each element has to appear explicitly in the note rather than by inference.

1. Laterality confirmed as left. The record has to name the left ulna. A note that says “ulna fracture” with no side needs a query, rather than a jump to the unspecified-side code.
2. Fracture location confirmed as upper end. The proximal ulna must be named, or implied by anatomical landmarks. A distal ulna fracture codes to S52.6x instead of S52.09x.
3. Fracture type classified as “other”. A documented olecranon fracture codes to S52.02x or S52.03x, and a coronoid fracture codes to S52.04x. S52.09x applies when no specific subtype is documented.
4. Encounter type documented as subsequent. The patient is back for ongoing management, not the first visit where the fracture was found and treated. ICD-10-CM defines a subsequent encounter as care that continues after the initial treatment phase ends.
5. Original wound classified as open type I or II. The Gustilo grade in the original operative note has to match. When that record is unavailable, query the provider rather than guess the grade.
6. Healing status documented as malunion. The clinician states malunion outright, or a radiology read confirms a healed fracture in an abnormal position. “Angulated healing” and “deformity at the fracture site with callus” both support malunion. A visible fracture line without callus points to nonunion instead. A clean claim for a fracture follow-up depends on this element being auditable before submission.

When the note reads ambiguously between malunion and nonunion, query rather than default. A 7th character that contradicts the initial encounter code can surface at a Medicare contractor during post-payment review.

Common coding errors with S52.092Q

Most rejections on this code come from the 7th character rather than the base code. These are the errors that show up most often on proximal ulna follow-up claims.

• Using G for malunion. G means a closed fracture with delayed healing. Malunion on an open type I or II wound is Q, and this swap is the single most common error on the code.
• Confusing malunion with nonunion. Q and M share the same wound grade and encounter type. Only the imaging separates them, so the radiology read has to be in the chart.
• Carrying the wrong Gustilo grade forward. A type III wound at the initial encounter becomes R at a malunion follow-up, never Q. The original operative note governs.
• Coding an olecranon or coronoid fracture to S52.09x. Named subtypes have their own subcategories. S52.09x is reserved for proximal ulna fractures that none of them cover.
• Reporting the unspecified-side code when the side is known. S52.099Q invites a specificity denial whenever the chart names the left ulna.
• Reusing the prior visit’s 7th character. The character reflects healing status at this encounter. A patient coded H for delayed healing in March may well be Q in September.

Associated CPT codes for proximal ulna fracture treatment

S52.092Q is a diagnosis code, so every claim pairs it with a procedure code. The CPT code reflects what happened at this encounter, which is usually corrective or aftercare work rather than the original fracture treatment. These codes sit inside the wider CPT code set, alongside the casting, imaging, and wound-care families a malunion follow-up draws on.

Two payer rules deserve a check before submission. CPT pairing varies by payer, and NCCI edits bundle some of these codes together. Global periods matter more than usual here, since a malunion often follows operative treatment and much of the aftercare sits inside the surgical package.

Billable status, validity, and reimbursement notes

ICD-10 code S52.092Q is billable and specific. Payers adjudicating on ICD-10-CM accept it for fiscal year 2026 without an unspecified-code rejection. Specificity does not guarantee payment, though. Coverage policy decides that.

• Billable: yes, a specific code accepted at claim level
• Fiscal year validity: 2026, effective October 1, 2025
• POA indicator: exempt, since subsequent encounter codes fall outside present-on-admission reporting
• Payer note: some Medicare Administrative Contractors apply local coverage determinations to the corrective osteotomy procedures associated with malunion. Check LCD applicability before you submit.
• Sequencing: when the malunion is the reason for the visit, S52.092Q is normally the principal diagnosis. Code associated late effects or corrective procedure diagnoses as secondary.

Approximate synonyms and index entry paths

The ICD-10-CM alphabetical index reaches S52.092Q by several entry paths. For traumatic fractures the main term is always “Fracture”, with subterms for site, laterality, wound type, and outcome. Confirm every index reference against the AAPC ICD-10-CM code lookup.

• Fracture, traumatic, ulna, upper end, left, open, type I or II, with malunion
• Fracture, traumatic, proximal ulna, left, open, malunion
• Other fracture, upper end, left ulna, subsequent encounter, open fracture type I or II, malunion
• Malunion, fracture, ulna, upper end, left, open type I or II

The WHO browser gives international context for forearm fracture classification. The US clinical modification aligns with the WHO ICD-10 international classification but can differ from it. For US billing, always work from the current ICD-10-CM tabular list rather than the WHO version.

How Pabau supports fracture claim submission

In most orthopedic practices the 7th character gets checked twice. The coder picks it, and whoever works the denial three weeks later checks it again. The detail that decides the character sits in the operative note and the radiology read. It rarely travels with the charge, so the coder rebuilds the history by hand at every follow-up visit.

Practice management software like Pabau keeps that detail attached to the patient record instead. The original wound grade, the imaging, and the encounter history stay on the chart the coder is already reading. Choosing between G, H, M, P, Q, and R then takes one screen rather than a hunt through old files. That single record also supports cleaner claims management, which flags subsequent-encounter codes for review before they leave the practice.

Pabau also connects to Claim.MD, which submits ICD-10-CM coded claims to thousands of US payers, including Medicare, Medicaid, and Blue plans. Eligibility checks and ERA files come back against the same record. Reporting across initial and subsequent fracture encounters then shows where 7th character errors cluster, so you fix the pattern instead of the individual claim.

Send fracture claims out complete the first time

Pabau keeps the wound grade, the imaging, and the encounter history on the record your coder is already reading. Claims then submit through Claim.MD, with eligibility checks and ERA matching built in.

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Conclusion

The base code on a proximal ulna follow-up is rarely what fails. The 7th character is, because it reports a wound grade recorded months ago alongside a healing outcome recorded today. A coder who cannot see both records is guessing at one of them.

That makes the fix an upstream one. Keep the original Gustilo grade and the current radiology read on the same chart. Choosing between G, H, M, P, Q, and R then stops being a judgment call. Where either record is missing, query the provider and accept the delay.

Practices that see a steady volume of fracture follow-ups get the most out of a workflow that checks 7th character consistency before submission. Pabau pairs that check with the Claim.MD integration, so orthopedic and physical therapy practices can submit subsequent encounter claims accurately the first time. Book a demo to see how the workflow runs end to end.

Continue your research

Need a reference for electronic claim submission workflows? 837 file submission guide explains how ICD-10-CM diagnosis codes are structured and transmitted to clearinghouses.

Want to see how ERA responses confirm payment for fracture codes? Electronic remittance advice explained covers how payer ERA files report adjudication results for submitted diagnosis codes.

Looking for guidance on eligibility before a fracture follow-up visit? Insurance eligibility verification details how to confirm coverage ahead of subsequent encounter appointments.

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