ICD code S52.111G – Torus fracture of the upper end of the right radius

Key takeaways

ICD-10 Code S52.111G covers a torus (buckle) fracture of the upper end of the right radius, seen again for delayed healing.

The 7th character G fits only when documentation supports delayed healing past the expected recovery window. Using G on a routine follow-up instead of D is a common denial trigger.

Torus fractures of the proximal radius occur mostly in children, who typically heal in 3 to 6 weeks. Past that window, imaging or a provider attestation has to carry the delayed-healing finding.

Practice management software like Pabau links ICD-10 assignment to the billing workflow, so 7th character mismatches surface before submission.

ICD-10 Code S52.111G: Definition and code details

ICD-10 Code S52.111G is the billable ICD-10-CM diagnosis code for a torus fracture of the upper end of the right radius.

It applies at a subsequent encounter for a fracture with delayed healing. It is a leaf-level code, meaning no further specificity is available and it can be submitted directly on a claim. The billable 7-character torus codes under S52.111 entered the tabular list with the 2019 code year. They remain active in the 2025 and 2026 code years, as confirmed by the CDC/NCHS ICD-10-CM web tool.

Breaking down the code string is the fastest way to verify correct selection before claim submission. Fracture codes ask the coder to confirm four things at once: anatomy, laterality, fracture type, and encounter type.

No age or gender restrictions apply to ICD-10 Code S52.111G. While torus fractures are most common in pediatric patients, the code is valid for adults when the anatomic and encounter criteria are met. The applicable diagnosis classification system is ICD-10-CM, not ICD-10-PCS, which covers inpatient procedures.

Understanding the 7th character G in ICD-10 Code S52.111G

The 7th character G denotes a subsequent encounter for a fracture with delayed healing. Knowing what G means, and what it does not cover, prevents the most common denial pattern on this code family. The ICD-10-CM Official Guidelines for Coding and Reporting (Section I.C.19) define the boundary. Subsequent-encounter coding begins once active treatment has finished and the visit is routine care during the healing phase.

The full set of 7th characters available for S52.111 is listed below. Choosing the wrong one carries weight, because payers read the 7th character as a clinical assertion about the patient’s healing status.

Delayed healing (G) is distinct from nonunion (K). Delayed healing means the fracture is taking longer than expected to unite, but union is still anticipated. Nonunion means union has failed and is no longer expected without intervention. K typically triggers intervention planning. G covers watchful management, once the provider records that healing is running slower than expected for the patient’s age and fracture type.

Each character maps to a point in the healing course, not to a visit number. The timeline below is the quickest way to check a selection against the chart.

What is a torus fracture of the upper end of the right radius?

A torus fracture, also called a buckle fracture, is an incomplete fracture. Cortical bone buckles on the compression side without a complete break through the cortex. It occurs at the upper (proximal) end of the radius, the bone on the thumb side of the forearm.

The fracture pattern is almost exclusively a pediatric injury. Growing bone contains more cancellous bone relative to cortical bone, which makes it buckle under axial load rather than break through. The most common mechanism is a fall on an outstretched hand (FOOSH). Compressive force travels up the forearm and concentrates at the metaphysis near the growth plate.

• Mechanism: Axial compression from a FOOSH or direct impact to the proximal forearm
• Typical age group: Children aged 5 to 10 years, though adults with osteopenic bone can present similarly
• Radiographic finding: Cortical buckling or bulging visible on AP and lateral wrist or forearm films; no complete fracture line
• Expected healing timeline: 3 to 6 weeks with appropriate immobilization in typical pediatric patients; timelines vary by age, fracture severity, and patient comorbidities
• Relevance to G suffix: After 6 to 8 weeks without progression toward union, an undocumented G contradicts the chart

S52.111G vs adjacent codes: Choosing the right code

ICD-10 Code S52.111G belongs to the S52.111 family. Its members share the fracture type and site, then differ by 7th character and, laterally, by the final digit. Coders most frequently confuse S52.111G with S52.111D (routine subsequent care) and, less commonly, with S52.112G (left radius). The comparison table below covers the full S52.111 family plus the two laterality siblings. Confirm each descriptor against the CDC/NCHS tool for the current code year before submission.

Documentation requirements for S52.111G

The G suffix must be supported by explicit clinical documentation. A chart note that records a follow-up visit without addressing healing status does not justify ICD-10 Code S52.111G. Payers may deny the claim or request records. Whatever 7th character you assign, the provider’s own language has to reflect the healing status it asserts.

• Provider attestation of delayed healing: The treating clinician must document that the fracture is healing more slowly than expected. Phrasing such as “persistent fracture line with inadequate callus at X weeks” or “delayed union noted on imaging” is sufficient. Vague language, such as “patient still has some pain”, is not.
• Imaging evidence: A radiograph or MRI taken at the follow-up visit strengthens the record. Look for inadequate callus formation, a persistent fracture line, or missing cortical bridging. Attach the radiology report or include the imaging findings in the clinical note.
• Timeframe context: The note should state the time elapsed since the initial injury. Compare that against the expected healing window for the patient’s age and fracture type. Typical torus fractures in children heal in roughly 3 to 6 weeks. Documentation beyond that window without evidence of union supports G. Timelines vary by patient age, fracture severity, and comorbidities.
• Treatment plan for continued care: The note should specify what management is being continued or changed in response to the delayed healing finding. Examples include extended immobilization, an orthopedic referral, or additional imaging at 4 weeks.
• Laterality confirmation: The chart must specify right upper extremity. If documentation says only “wrist” or “forearm” without laterality, the coder cannot assign the 1 in the 5th position with confidence.

AHA Coding Clinic guidance reinforces that delayed healing is a clinical determination made by the treating provider, not a default selection. Coders should not assign G based on elapsed time alone.

CPT codes commonly paired with S52.111G

ICD-10 Code S52.111G appears on follow-up claims, not initial fracture treatment claims. CPT codes paired with S52.111G therefore reflect continued non-operative management, rehabilitation, or follow-up imaging rather than initial fracture reduction. Initial treatment codes for this site pair with S52.111A, never with S52.111G. They are 24650 for closed treatment of a radial head or neck fracture without manipulation, and 24655 with manipulation. Submitting an initial-treatment CPT code with the G suffix is a CPT-to-ICD mismatch and a reliable denial trigger.

CPT codes for casting application or removal (e.g., 29085, 29125) may also appear alongside S52.111G when continued immobilization is part of the delayed-healing management plan. Verify payer-specific coverage policies before assuming these combinations will be reimbursed. Claims software built for practices can flag payer LCD edits at the point of submission. CPT appropriateness is presented here as examples only, and local coverage determinations vary by payer.

Payer coverage and medical necessity for S52.111G

Medicare, Medicaid, and commercial payers read ICD-10 Code S52.111G as a medical-necessity claim. The visit is billed as management of a fracture with documented delayed healing. The payer’s expectation follows from that: the encounter must be clinically distinct from a routine check-in. Payers may flag claims when delayed healing is asserted without corroborating documentation, particularly when the time since initial fracture falls within the standard healing window.

• Medicare: Claims under Part B for outpatient follow-up visits must demonstrate medical necessity for the level of evaluation and management billed. A physician’s note documenting imaging findings and a revised treatment plan satisfies this requirement more reliably than a brief progress note.
• Medicaid: State Medicaid programs vary; some require prior authorization for follow-up orthopedic visits beyond a specified number. Confirm the state-specific coverage policy before billing extended fracture management.
• Commercial payers: Many commercial plans follow CMS LCD guidance. Some add documentation requirements, or cap covered follow-up visits where the record shows no clinical change. Some payers require a radiology report attached to the claim for delayed-healing codes.

Staying compliant on this code is principally a documentation challenge. The clinical finding must drive the code selection, never the other way round.

Common claim denial reasons for S52.111G

Claim denials on S52.111G are widely reported in coding forums and AAPC educational content as a known risk pattern, though individual payer data varies. Three denial codes come up most often on fracture 7th character errors. They are CO-4 (procedure code inconsistent with modifier), CO-11 (diagnosis inconsistent with procedure), and CO-197 (precertification or authorization absent).

• Wrong 7th character (D coded as G or vice versa): Using G when the documentation only supports routine healing is the most common error. Coders sometimes default to G because the visit extends beyond the initial episode, but D is correct whenever healing is progressing normally.
• Laterality mismatch: Coding S52.112G (left) against a chart that documents the right forearm triggers an edit or clinical audit. So does S52.119G where laterality is documented.
• Parent code submitted instead of full code: Submitting S52.111 without a 7th character is not a billable code. Claims must use the full 7-character string S52.111G.
• Encounter type mismatch: Billing S52.111G on an initial treatment date of service creates a clinical inconsistency payers will flag. So does billing it on a visit where new active treatment starts, which should revert to A.
• Missing documentation: A claim with no chart note or radiology report supporting delayed healing raises audit and denial risk. That risk climbs past 10 to 12 weeks post-injury.
• CPT-to-ICD mismatch: Pairing an initial-treatment CPT such as 24655 with S52.111G is inconsistent. The procedure performed contradicts the encounter type the diagnosis code asserts.

Pre-submission claim scrubbing is where most of this gets caught. Correcting a 7th character mismatch in the billing queue costs a fraction of what the same error costs once it comes back as an appeal.

Coding tips and best practices for S52.111G

Three things must align before the claim on ICD-10 Code S52.111G is built. The chart confirms right laterality. The provider has explicitly documented delayed healing. The CPT code reflects a follow-up encounter rather than active treatment. When all three are present, the claim is defensible. When any one is missing, the practice is exposed to denial or post-payment audit.

• Confirm laterality in the chart first: Do not rely on the intake form or the order screen. Check the provider’s note or the radiology report for an explicit statement about right or left before assigning the 5th digit.
• Document the expected healing timeline: The note should state how long the fracture has been present, and what the expected healing window was. The comparison is what supports the G suffix clinically.
• Use ICD-10-CM Official Guidelines Section I.C.19: This section governs fracture coding logic and defines the encounter-type categories. It is the primary reference when a payer or auditor challenges code selection.
• Respect the 3 to 6 week healing window: A visit inside it coded with G, without strong imaging or clinical evidence, invites scrutiny. Delayed healing in a child should be clinically documented with imaging findings, not inferred from visit timing alone.
• Leverage clean-claim workflows: Clean claim submission protocols that include 7th character validation reduce the volume of downstream rework. Set up a billing queue review step specifically for fracture codes with subsequent-encounter suffixes.
• Review the full S52.111 family before coding: S52.111S may fit better once the fracture has united and the visit addresses residual stiffness. If union has failed entirely, K replaces G.

How Pabau keeps 7th character mismatches out of the billing queue

In most practices the chart note and the claim live in separate systems. A coder reads the follow-up note, picks a 7th character from memory or from a cheat sheet, and the claim goes out. Nobody compares the suffix against the date of the initial encounter until the remittance advice comes back.

Pabau is practice management software that keeps the note, the code and the claim on the same patient record. When a coder assigns S52.111G, the encounter history sits beside it. A G applied four weeks after the A encounter shows up before the claim is queued. Imaging reports and provider attestations stay attached to the same record, which is what an auditor asks for later.

The outcome is fewer fracture claims coming back for records. Denials that used to surface weeks after submission get resolved while the patient is still in follow-up. The billing team works a shorter rework list.

Catch 7th character errors before the claim goes out

Pabau links ICD-10 code assignment to your billing workflow, so CPT-ICD mismatches are flagged before claims leave the practice rather than after they bounce.

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Conclusion

ICD-10 Code S52.111G asks for precise documentation, not just a precise code. G asserts a clinical finding of delayed healing, and that finding has to appear in the provider’s note. Imaging should back it wherever the record allows.

Choosing correctly between D, G, K and P decides whether follow-up fracture claims pay on first submission or cycle through appeals. One review step in the billing queue for every fracture code carrying a subsequent-encounter suffix removes most of that risk. Book a demo to see how Pabau surfaces CPT-ICD mismatches on orthopedic follow-up claims before they leave your practice.

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