ICD code S52.355C – Nondisplaced comminuted fracture of shaft of radius

Key takeaways

ICD-10 code S52.355C covers a nondisplaced comminuted fracture of the radial shaft, left arm. The 7th character C marks an initial encounter for an open type III fracture.

The code lives in S52.3, the shaft of radius family. It is not a distal radius code, because wrist-end fractures are coded from S52.5 instead.

Character C covers Gustilo types IIIA, IIIB, and IIIC together. ICD-10-CM does not split those subtypes, so the surgeon’s documented grade drives management, not code choice.

There is no S52.359. Unspecified laterality in the shaft family is S52.356C, and the right-arm equivalent of this code is S52.354C.

Practice management software like Pabau pre-fills the claim form from the patient record and supplies ICD-10-CM and CPT lookup libraries. It also checks that required claim fields are complete before submission.

ICD-10 code S52.355C is billable at seven characters

S52.355C is a billable ICD-10-CM diagnosis code, valid for encounters from October 1, 2015 onward.

The full descriptor reads: Nondisplaced comminuted fracture of shaft of radius, left arm, initial encounter for open fracture type IIIA, IIIB, or IIIC.

Every character in S52.355C carries one clinical fact

Each character encodes one clinical attribute. Read the structure and you can spot missing documentation before submission, rather than after a denial arrives.

The 4th character is the one that gets miscoded. ICD-10-CM divides the radius into three regions. S52.1 covers the upper end, S52.3 the shaft, and S52.5 the lower end. Colles’, Smith’s, torus, and radial styloid fractures all live in S52.5, and none of them takes an S52.35x code.

If the operative note describes a wrist-end injury, S52.355C is the wrong stem. The map below shows which fractures belong to which region.

A comminuted shaft fracture usually points to high-energy trauma. That same energy drives bone through skin and puts the injury into open fracture territory. It explains why the 7th character carries so much weight on this code.

The 7th character follows the care, not the visit count

Most billing errors on this code start at the last character. Per the ICD-10-CM Official Guidelines published by CMS and NCHS, the encounter character is a clinical determination.

Initial encounter applies for the whole active treatment phase, however many appointments that takes. Assign the character from the care being delivered, not from the sequence of visits.

S52.355 accepts sixteen 7th characters. The table below lists all of them, applied to a nondisplaced comminuted fracture of the left radial shaft.

Character C is the one that produces S52.355C. It marks an initial encounter for an open fracture graded Gustilo IIIA, IIIB, or IIIC.

All three subtypes collapse into that single character, because ICD-10-CM does not separate them at code level. One pairing in this table catches people out. N belongs to open type III nonunion, while P belongs to closed malunion.

Take a worked case. A cyclist arrives with the left radius broken into four fragments and a 12 cm wound exposing muscle. The surgeon documents a type IIIB open fracture, and imaging shows no displacement.

That encounter codes to S52.355C. Six weeks later, at a follow-up where the bone is healing normally, the same injury codes to S52.355F.

Gustilo grades IIIA, IIIB, and IIIC all collapse into character C

The Gustilo-Anderson classification is the framework surgeons use to grade open fracture severity. ICD-10-CM builds the open fracture 7th characters for S52 directly on it, so the coder depends on the documented subtype.

Grading a wound as IIIA, IIIB, or IIIC is a clinical judgment. It belongs to the treating orthopedic surgeon, not to the billing team.

Type IIIC carries a very different clinical trajectory from IIIA, including the risk of amputation when vascular repair fails. ICD-10-CM still groups all three under character C, because the classification captures severity rather than the management pathway.

So ask surgeons to write the subtype in full. “Type IIIA open fracture of the left radial shaft” gives the coder what it needs. “High-energy open fracture” does not.

Where S52.355C sits, and why S52.359 does not exist

S52.355C sits inside a strict hierarchy, and each level adds one fact. Reading the chain from the top is the fastest way to check your work. Anatomy, fracture pattern, displacement status, and laterality all have to match the record.

There is no S52.359. In the S52.3 shaft family the unspecified-arm code ends in six, not nine. Unspecified laterality is S52.356, and its open type III initial encounter is S52.356C.

Coders who pattern-match from the distal radius codes submit a stem that does not exist, because unspecified laterality does end in nine there. Pull the exact descriptor from our diagnostic code lookup before you commit to a neighboring stem.

Query the surgeon when the side is missing rather than defaulting to the unspecified code. Unspecified laterality loses clinical specificity and invites extra payer scrutiny on a claim that is already expensive.

Five guideline rules decide whether the record supports S52.355C

The ICD-10-CM Official Guidelines for Coding and Reporting set the rules for traumatic fractures in section I.C.19.c. Five of them decide whether the record in front of you supports S52.355C.

• Active treatment means initial encounter: Per guideline I.C.19.c, the initial encounter characters apply for the whole active treatment phase. A patient whose fracture is repaired at a second visit still takes character C while active treatment continues.
• Subsequent encounter begins at routine aftercare: Once active treatment ends and the patient moves into monitoring or rehabilitation, switch to the matching subsequent encounter character. Which one applies depends on fracture type and healing status.
• Undocumented displacement defaults to displaced: The guidelines are explicit that a fracture not documented as displaced or nondisplaced is coded as displaced. For a left open type III comminuted shaft fracture that points to S52.352C, not to S52.355C.
• Undocumented open or closed defaults to closed: A fracture not documented as open is coded as closed. The encounter then takes character A, unless the surgeon explicitly documents a Gustilo type III wound.
• Laterality is coded to the highest specificity available: A left radial shaft fracture takes S52.355C and a right one takes S52.354C. Use S52.356C only when the record genuinely cannot establish the side.

A clean claim on an open fracture depends on five documented facts. The record has to show the site, the pattern, the displacement status, the laterality, and the encounter type.

Radial shaft repairs bill from CPT 25500 through 25526

S52.355C is a diagnosis code, so the procedure side of the claim is coded separately. Radial shaft fractures are treated under CPT 25500 through 25526. The distal radius codes in the 25600 series do not apply here. That pairing error follows naturally once the anatomy has been misread.

Three codes in the range cover a Galeazzi injury, where the shaft fracture comes with a distal radioulnar joint dislocation. 25520 treats both closed, 25525 opens the shaft only, and 25526 opens both.

An open type III wound usually generates a debridement code alongside the fracture repair. CPT 11010 covers skin and subcutaneous tissue, CPT 11011 adds muscle fascia and muscle, and 11012 adds bone. Select by the deepest tissue debrided, and check the AMA CPT manual for the current code year before you bill.

Payer policies on diagnosis-to-procedure pairing vary, so confirm the payer’s own rules ahead of submission.

Five mistakes that get an S52.355C claim denied

Open fracture codes generate a disproportionate share of orthopedic denials. Five errors account for most rejections on S52.355C, and a billing team works faster once it can name them.

1. Coding a wrist fracture into the shaft family: A distal radius fracture belongs in S52.5, not S52.3. If the note says Colles’, Smith’s, radial styloid, or distal radius, then S52.355C is wrong and the claim fails on medical necessity.
2. Wrong 7th character for the fracture type: Assigning C when the operative note documents Gustilo type I or II is a common slip. So is assigning B when the surgeon documents type III. Confirm the grade in the surgeon’s own words.
3. Using C on a closed fracture: Character C requires a documented open wound. Coding it on a closed injury draws denials and audit attention. A high-energy shaft fracture without a skin breach still takes character A.
4. Assuming nondisplaced: If the record does not say the fracture is nondisplaced, the guidelines send you to the displaced code. Query the surgeon instead of inferring alignment from the imaging report.
5. Submitting S52.359C: That code does not exist. Unspecified laterality in this family is S52.356C, and the invented stem is rejected before the claim reaches adjudication.

Before you submit: what the record has to prove

An open fracture claim passes through four hands before a payer sees it. The emergency team records the injury. The surgeon grades the wound and repairs the bone. A coder builds the diagnosis and procedure lines, and a biller sends the claim on to the clearinghouse.

Every handoff is a chance for the 7th character to drift away from the operative note. So run this check before the claim leaves the practice.

• An operative note that names the shaft of the radius and describes the fracture pattern.
• A Gustilo subtype written out as IIIA, IIIB, or IIIC, in the surgeon’s own words.
• An explicit statement that the fracture is nondisplaced, rather than an inference from imaging.
• Laterality on the diagnosis line and the procedure line, both of them saying left.
• A CPT code that matches the procedure performed, not the one planned in the consent.
• The payer’s own policy on diagnosis-to-procedure pairing for open fracture repair.

A missing item on that list is a query for the surgeon, not a judgment call for the coder.

How the 7th character changes as the fracture heals

Type III open shaft fractures often need months of follow-up, and the 7th character moves as the clinical picture changes. The stem stays S52.355 for the left radial shaft, and only the last character changes.

Nonunion (character N) and malunion (character R) both need explicit surgeon documentation. Delayed healing on its own does not establish nonunion, so character N applies only when the record states that union has failed.

Character S is reserved for a late effect of the original fracture, never for the fracture itself. Lost forearm rotation after the shaft has united is the kind of residual condition it captures.

Where Pabau takes the retyping out of fracture claims

A fracture claim usually breaks down at the handoffs. The surgeon dictates the Gustilo grade in one system. The coder looks up the stem in another, and someone retypes both onto the claim form.

Practice management software like Pabau keeps the record and the claim in one place. The operative note, the encounter diagnosis, and the charge line all sit against the same patient record. Pabau’s built-in claims management pre-fills the claim form from that record instead of asking anyone to rekey it.

Searchable ICD-10-CM and CPT lookup libraries let a coder check the S52.3 family without leaving the claim. Before the claim can go, Pabau confirms that the fields the payer requires are populated.

Submission then runs through the connected clearinghouse, which is Claim.MD in the US. Eligibility checks, claim status tracking, and remittance posting sit on that same pipeline. Your coders still make the coding call, and Pabau takes the clerical work off them.

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Conclusion

Check the region before you check the rest of this code. S52.3 and S52.5 read alike at a glance. A wrist-end fracture coded into the shaft family fails on medical necessity, however careful the rest of the coding was.

After the region, the wound grade decides the claim. Character C stands or falls on the words IIIA, IIIB, or IIIC appearing in the operative note. Ask for them at the encounter, while the surgeon still has the case in mind.

Get those two right and an S52.355C claim usually goes out clean the first time. Book a demo to see how Pabau pre-fills fracture claims, checks the required fields, and sends them to your clearinghouse.

Continue your research

Need to see how electronic claim validation works? Claim.MD clearinghouse overview covers claim submission, payer edits, and remittance posting on the US pipeline.

Want to understand denial patterns for orthopedic claims? Medical billing compliance guide explains the regulatory framework and audit triggers behind open fracture and surgical claims.

Coding a different fracture pattern in the same family? ICD-10 code S52.333C covers a displaced oblique fracture of the radial shaft with the same open type III 7th character.

The record never names the side? ICD-10 code S52.356C sets out the unspecified-arm version of this fracture and when it holds up.

Both forearm bones broken? CPT code 25565 covers closed treatment of radial and ulnar shaft fractures together.

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