ICD code S62.011K – Displaced fracture of distal pole of navicular [scaphoid] bone

Key takeaways

S62.011K describes a displaced fracture of the navicular (scaphoid) bone of the right wrist. It is reported at a subsequent encounter once the fracture has failed to unite.

The 7th character K is not interchangeable with D (routine healing) or G (delayed healing). Using the wrong suffix is a common audit trigger and denial reason.

Scaphoid nonunion is clinically distinct from malunion. Nonunion means the fragments have not bridged, while malunion means they healed in an incorrect position.

Surgery to repair a documented nonunion keeps the K suffix. It does not restart active treatment, so the encounter is not recoded to S62.011A.

Claims management software like Pabau helps orthopedic and hand surgery practices submit and track clean claims through the Claim.MD clearinghouse integration.

ICD-10 code S62.011K: Definition and clinical overview

S62.011K is the billable ICD-10-CM code for a displaced fracture of the navicular (scaphoid) bone of the right wrist. It is reported at a subsequent encounter where the fracture has resulted in nonunion. Specifically, the code applies from the point imaging confirms the fragments have not bridged. Until then, the routine-healing (D) or delayed-healing (G) suffix is correct.

The code sits in the ICD-10-CM structure for injuries of the wrist and hand. It belongs to category S62 (fracture of wrist and hand) and subcategory S62.0 (fracture of navicular bone). The 011 subcode then specifies that the fracture is displaced and involves the right wrist.

The trailing K identifies the encounter as a follow-up visit where healing has not occurred as expected. Per the CMS ICD-10-CM guidelines, the code is therefore billable and valid for the current fiscal year.

What S62.011K means: Breaking down the code

ICD-10-CM codes are alphanumeric and encode several clinical facts at once. For example, each segment of S62.011K has a precise meaning. As a result, reading the structure is what prevents the most common coding errors.

ICD-10-CM uses the term “navicular bone”, while orthopedic clinicians almost universally call it the scaphoid. In other words, both terms name the same carpal bone, and the bracketed notation “navicular [scaphoid]” exists to acknowledge that split. The same A/D/G/K/P/S structure runs across the whole S60-S69 chapter. In addition, the ICD-10-CM code library lists the neighboring injury codes a wrist claim often touches.

The 7th character K: Subsequent encounter with nonunion

Assigning the wrong 7th character for a fracture encounter is one of the most frequently cited audit findings in orthopedic billing. For that reason, the table below shows the full S62.011 family across all valid 7th characters.

The K and P codes are the easiest pair to conflate. Nonunion (K) means the fracture gap remains open, with no bony bridging confirmed on imaging. In contrast, malunion (P) means the bone has healed, but in an incorrect position that produces deformity or functional loss.

Those are different clinical and surgical problems, and payers treat them differently on review. So, document which one is confirmed radiographically before you assign the 7th character.

Code variants and related scaphoid nonunion codes

Scaphoid fracture coding requires both the correct displacement status and the correct laterality. The table below covers the most frequently referenced adjacent codes for quick coder comparison. Still, verify against the CDC/NCHS ICD-10-CM web tool for the current fiscal year before billing.

For a wider view of how 7th character families work across the injury chapters, the AAPC ICD-10-CM lookup offers keyword search with full tabular context.

Clinical context: displaced scaphoid fracture with nonunion

Scaphoid fractures account for roughly 60-70% of all carpal bone fractures. As a result, they are the most common carpal injury seen in orthopedic and hand surgery practices.

The scaphoid’s vulnerability to nonunion comes from its retrograde blood supply. The distal pole is vascularized adequately, but the proximal pole is fed by vessels that enter distally and travel proximally. As a result, a fracture across the waist interrupts that flow to the proximal fragment.

Nonunion develops in approximately 10-15% of scaphoid fractures, with displaced fractures carrying a substantially higher risk than nondisplaced ones. In particular, several factors increase the likelihood of a nonunion outcome:

• Delayed diagnosis (fractures missed on initial plain films are common)
• Proximal pole fracture location, which has the poorest blood supply
• High degree of displacement at the fracture site
• Patient non-compliance with immobilization
• Avascular necrosis of the proximal fragment

For orthopedic and hand surgery practices, recognizing scaphoid nonunion early is critical. Patients often present with persistent radial-sided wrist pain, reduced grip strength, and wrist stiffness months after the original injury. In addition, anatomical snuffbox tenderness persists on examination. CT imaging is the standard for confirming nonunion, since plain films may underestimate fragment separation.

When to use S62.011K versus other wrist fracture codes

Three conditions must all be true before S62.011K is the correct code. Otherwise, getting any one wrong produces a technically incorrect claim.

• Displacement confirmed: The fracture fragments are not in anatomic alignment. If the fracture is nondisplaced, use S62.021K (right wrist) instead.
• Right wrist laterality documented: Left wrist nonunion is S62.012K. Generally, unspecified laterality (S62.013K) should only be used when the medical record genuinely does not specify, which is rare in orthopedic documentation.
• Encounter type is subsequent with confirmed nonunion: The patient is not presenting for the first time, which would be S62.011A. The fracture has also not healed normally (S62.011D) or partially (S62.011G). Finally, nonunion requires radiographic confirmation of failed bridging.

The record, not the calendar, decides which suffix is correct at each of those encounters.

One sequencing question comes up whenever surgical repair of the nonunion is scheduled. Coders often assume the operation restarts active treatment and switch the 7th character back to A. In fact, it does not.

Per the ICD-10-CM Official Guidelines, surgery to correct a documented nonunion or malunion still takes the subsequent-care 7th character. As a result, S62.011K stays on the claim for the bone grafting encounter. The one exception is a patient who delayed treatment of the original fracture and is only now presenting for initial care.

Billing and documentation requirements for S62.011K

Accurate diagnosis coding for S62.011K is only half the claim. In addition, the procedure codes and documentation attached to it determine whether the claim clears the clearinghouse and pays on first submission.

CPT codes commonly paired with S62.011K

Scaphoid nonunion typically requires surgical intervention. Accordingly, the CPT codes used depend on the procedure performed at the encounter being coded.

Practices that also code the non-surgical side of scaphoid care should check CPT 25624 for closed treatment with manipulation. Notably, it pairs with the initial-encounter and routine-healing suffixes rather than K.

Documentation requirements

Every claim carrying S62.011K should be supported by documentation that clearly establishes all three code elements: displacement status, laterality, and nonunion confirmation.

• Imaging report (CT preferred, X-ray acceptable) confirming absence of fracture bridging
• Explicit laterality notation in the clinical note (right wrist)
• Time from initial injury (helps support nonunion designation vs. delayed healing)
• Clinical findings consistent with nonunion: persistent pain, tenderness at the fracture site, reduced function
• Prior treatment history (casting, splinting, prior surgical attempts)

Both the code set and the payer rules shift every year. CMS publishes annual ICD-10-CM updates that can change the valid code set, and payer LCD policies for scaphoid nonunion repair vary by carrier. For that reason, re-check the code against the CDC/NCHS web tool linked above before the first claim of each fiscal year.

How Pabau helps practices get nonunion claims paid on first pass

Most orthopedic billing teams work a nonunion claim across three disconnected places. The coder reads the imaging report in the chart, then keys S62.011K and the CPT code into a separate billing tool. A denial explanation arrives weeks later in a paper or PDF remittance.

Practice management software like Pabau keeps that sequence in one record. For example, Pabau’s claims software for specialists submits electronically through the Claim.MD clearinghouse, which reaches thousands of US payers. Each electronic remittance advice, or ERA, posts back against the claim it belongs to.

So when a scaphoid nonunion claim comes back short-paid, the adjustment reason code is already on the claim your biller opens. They can correct the encounter suffix or the procedure code and resubmit the same day, rather than reconciling a remittance file by hand.

Reduce orthopedic billing denials with Pabau

Pabau’s claims management tools submit orthopedic claims through the Claim.MD clearinghouse and track every ERA. Your billers see a denial reason the day it lands, not weeks later.

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Conclusion

S62.011K is the right code when three facts sit in the same encounter: displacement, right-wrist laterality, and radiographically confirmed nonunion. First, two of those come from the note. The third, meanwhile, comes from the imaging report, which is why the CT result belongs in the chart before the claim goes out.

The suffix is the part worth slowing down for. In fact, K survives the surgical encounter. Switching it back to A because an operation happened is the error that brings an auditor back through the whole episode. Book a demo to see how Pabau tracks a scaphoid nonunion claim from the imaging note through to the remittance.

Continue your research

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