ICD code S62.161S – Displaced fracture of pisiform

Key takeaways

S62.161S is the billable ICD-10-CM code for a displaced fracture of the pisiform, right wrist, sequela.

The parent code S62.161 is not billable, because every S62 fracture code needs a 7th character.

Seven 7th characters are valid on S62.161, not three, and the full set is A, B, D, G, K, P and S.

The sixth digit carries displacement and side together, so there is no separate laterality digit and no 9.

Pair S62.161S with a code for the residual condition, and document the causal link in the assessment.

S62.161S is billable, but only with the S in place

S62.161S is a valid, billable ICD-10-CM diagnosis code. Its official description is Displaced fracture of pisiform, right wrist, sequela. It holds for the FY 2026 code set, and it goes on claims to Medicare, Medicaid and commercial payers under HIPAA-covered transactions.

Strip the S off and you have S62.161, which no payer will accept.

Before a payer checks the code for you, the CDC/NCHS ICD-10-CM web tool confirms year-specific codes straight from the tabular list.

How to read S62.161S, digit by digit

Read the code left to right and each segment adds one fact. The sixth digit is the one that trips coders up, because it does two jobs at once.

• S62 – Fracture at wrist and hand level, the category covering every hand and wrist fracture
• S62.1 – Fracture of other and unspecified carpal bone(s)
• S62.16 – Fracture of pisiform, covering displaced and nondisplaced fractures alike
• S62.161 – Displaced, right wrist. This one digit sets displacement and side together
• S – Sequela, the 7th character that makes the code billable

That sixth digit is where the confusion starts. It is not a plain laterality digit, and there is no 9 for an unspecified side. Values 1 to 3 cover displaced fractures, right then left then unspecified. Values 4 to 6 repeat that run for nondisplaced fractures. So S62.160 and S62.169 do not exist, however often they turn up in code lists.

The grid below maps all six codes onto the two axes the digit actually encodes.

When displacement is not documented

ICD-10-CM defaults to displaced when the note stays silent. That default hands you a billable code, but it does not protect the claim. A payer that finds “displaced” coded with no imaging or operative note behind it can deny or ask for records. State displacement in the assessment and the question never comes up.

Why a pisiform fracture leaves sequelae worth coding

The pisiform is the smallest of the eight carpal bones. It sits in the proximal row on the ulnar side of the wrist, wrapped inside the tendon of the flexor carpi ulnaris. That makes it a sesamoid bone, so it transmits force rather than carrying axial load directly.

Most of these fractures follow a fall on an outstretched hand, a direct blow to the ulnar wrist, or repeated stress in sport. Racket sports, golf and baseball produce more than their share.

What comes after the fracture is the part that ends up on a sequela claim. Chronic ulnar-side wrist pain, grip weakness, pisotriquetral arthritis and flexor carpi ulnaris irritation all outlast the bone healing. Those residual problems are the reason to reach for S62.161S instead of the A or D variants.

Seven 7th characters are valid for S62.161, not three

Every fracture code in the S62 block needs a 7th character, and S62.161 has seven legal options. Plenty of reference pages show only A, D and S as options. That shortfall costs claims, because an open fracture or a nonunion gets forced into the wrong bucket.

A and B split the initial encounter by open or closed

Both characters cover active treatment, and the skin is what separates them.

B applies where the fracture site communicates with the outside, which is rare in the pisiform but possible after a crush injury. A covers the rest of the active phase.

Either one holds for as long as active treatment continues, even if a second provider takes over partway through.

D, G, K and P all mean subsequent, for four different reasons

All four describe a visit after active treatment ended, and healing status picks between them.

D is the routine case, covering a cast check, a therapy review or wound monitoring. G says healing is slower than expected. K says the fracture has not united at all, and P says it united crooked.

Coders who only know D under-report the harder cases, which matters because the note almost always says which one applies. A radiology line reading “nonunion at six months” is the difference between S62.161D and S62.161K.

S means the bone healed and something else did not

S62.161S applies when the fracture is behind the patient but its consequences are not. Grip strength has not come back, the ulnar wrist still hurts, or the pisotriquetral joint has degenerated.

A sequela encounter takes two codes. One names the residual condition being treated, and S62.161S explains where it came from.

Sequela or subsequent? The reason for the visit decides

The choice between D and S is clinical, never chronological. Months elapsed since the injury do not enter into it. What the patient came in for does, and that is the single question to ask before picking a character.

Four rules the official guidelines set for fracture sequela

The ICD-10-CM Official Guidelines for Coding and Reporting are maintained jointly by CMS and the National Center for Health Statistics. Four of their rules govern a claim like this one.

• The sequela code sits after the code for the residual condition, never ahead of it
• The S character applies only once the fracture itself has healed
• Active fracture care and sequela coding cannot share an encounter
• No minimum or maximum time applies to the S character, so the calendar is irrelevant

In practice, that first rule decides how the claim lines up. The wrist pain or the arthritis leads, and S62.161S follows it as the explanation.

Where S62.161S sits, and what the Excludes notes rule out

The hierarchy earns its keep twice. It shows which digit to change when the documentation changes, and it shows which injuries belong somewhere else entirely.

The Excludes notes, and why the numbers matter

Two notes sit at the S62 category level, and they behave differently. An Excludes1 note is a hard stop, while an Excludes2 note simply says the two conditions are separate.

• Excludes1: traumatic amputation of wrist and hand (S68.-) – never report both. If the hand or wrist was amputated, the S68 code replaces the fracture code.
• Excludes2: fracture of distal parts of ulna and radius (S52.-) – the two can coexist. A distal radius fracture alongside the pisiform fracture gets its own S52 code.
• Excludes2 at S62.1: fracture of scaphoid of wrist (S62.0-) – the scaphoid has its own subcategory, so it never rides along under S62.1.

The five sibling codes coders reach for by mistake

Each of the other five S62.16 codes describes the same small bone. Displacement, side, or both is what changes. The sequela form of each one takes the same S in the seventh position.

One trap sits in that table. S62.164 is not the fallback for missing documentation, because the default runs the other way. Reach for a nondisplaced code only where the record confirms the fragments held position.

S62.163 and S62.166 are the ones to avoid whenever the chart names a side. Payers read an unspecified-side wrist code as a documentation problem, because almost every wrist X-ray is labeled.

Our ICD-10-CM code index covers the neighboring carpal subcategories, and the AAPC Codify lookup shows the full S62 range in one screen.

What a payer needs to see in the note

A sequela claim stands or falls on the causal link. Either the note draws a line from the old fracture to today’s problem, or it does not. Reviewers looking at S62.161S check for five specific elements.

• Prior injury history: the note references the original fracture, ideally with a date of injury or the treating facility
• Causal relationship: the assessment says in words that today’s pain, arthritis or weakness came from that fracture
• Residual condition code: a separate code names what is being treated, sequenced ahead of S62.161S
• Displacement evidence: the original imaging or operative note, or a reference to it, showing fragments out of alignment
• Consistent laterality: right wrist reads the same way across the chart, because a conflicting side triggers payer queries

How the claim moves, and where it usually stalls

Coding sits in the middle of this process, not at the end. Following one S62.161S claim from the exam room to the remittance shows where it tends to stop.

1. The visit gets documented. The provider records the residual condition, the original fracture and the link between them.
2. The coder builds the diagnosis string. The residual condition code leads and S62.161S follows, in that order.
3. The claim gets scrubbed. Edits catch a truncated S62.161 or a missing 7th character before the claim leaves the practice.
4. The clearinghouse validates and forwards it. Format problems bounce back within hours at this step, not weeks later.
5. The payer adjudicates. A sequela code sitting alone, with no residual condition code beside it, is the usual trigger for a records request.

Before you submit: A five-point check

• The code reads S62.161S, not S62.161
• A residual condition code sits ahead of it on the claim
• Displacement appears somewhere in the record, not only in the code
• Right wrist is stated in the note, the imaging report and the claim
• The assessment names the old fracture as the cause, in words a reviewer can quote

A scrubber catches the first two points on that list. Whoever reads the note has to catch the other three. That is why practices with a working denial management process see fewer of these claims come back.

The mistakes that turn a sequela claim into a denial

Five errors account for most of the lost claims on displaced pisiform fractures. The list below runs in rough order of what each one costs.

• Using D when the encounter is a sequela. A patient back 18 months later with pisotriquetral arthritis is an S encounter. The test is the reason for the visit, and elapsed time has no bearing on it.
• Submitting S62.161 with no 7th character. The six-character parent is not billable, so the claim rejects. Append one of the seven valid characters: A, B, D, G, K, P or S.
• Leaving S62.161S to stand alone. A second code naming the residual condition is required, such as M25.531 for pain in the right wrist.
• Coding displaced when the record says nondisplaced. Auditors flag the inconsistency quickly. The correct code in that case is S62.164S.
• Mixing up laterality. Right wrist is S62.161S and left is S62.162S. One chart line reading “left” undoes the rest of the file.

How Pabau keeps ICD-10 sequela claims clean

Most of what goes wrong above happens between the note and the claim. The provider writes the causal link into the assessment. The coder reads it a day later, and the residual condition code gets left off because the two live in different systems.

Practice management software like Pabau keeps them in one record. Diagnosis codes attach to the treatment note as it is written, so the coder sees the causal sentence and the code side by side. Pabau’s software for billing teams then validates the diagnosis string before submission, which is where a missing 7th character shows up cheaply.

Claims go out through our Claim.MD integration, which reaches thousands of US payers for electronic submission and real-time eligibility checks. So problems on a sequela claim surface the same day. You correct a character instead of appealing a denial three weeks later.

Catch ICD-10 coding errors before the payer does

Pabau attaches diagnosis codes to the treatment note and validates them before submission. Claims reach thousands of US payers through our Claim.MD integration, so sequela claims come back to you less often.

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Conclusion

The hard part of S62.161S was never looking it up. It is proving, in the note, that today’s wrist problem traces back to a fracture that healed a year ago. Get that one sentence into the assessment and the code follows almost by itself.

Specificity cuts both ways, and that is the trade-off worth remembering. S62.161S claims displacement, a right wrist and a causal chain, so a reviewer can check all three. That is a good bargain where the record supports it, and an expensive one where it does not.

Sequela coding is also where any split between the clinical note and the billing screen shows up first. Book a demo to see how Pabau ties diagnosis coding to the note it came from.

Continue your research

Need to understand the full claims submission workflow? Claim.MD clearinghouse overview covers how electronic claim submission and payer connectivity work for US practices.

Managing denials on injury-related claims? Denial codes in medical billing explains common CARC denial reason codes and how to respond to them.

Want to understand clean claim requirements? Clean claim standards outlines the documentation and coding requirements that prevent rejections before they happen.

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