ICD-10 code S62.367S: fifth metacarpal fracture sequela

Key Takeaways

ICD-10 code S62.367S describes a nondisplaced fracture of the neck of the fifth metacarpal bone, left hand, sequela – clinicians use it for late-effect complications after the fracture has healed.

The 7th character ‘S’ designates sequela: a condition (such as stiffness, malunion pain, or tendon restriction) arising as a direct result of the original injury.

Sequela codes like S62.367S should not be used as standalone primary diagnoses; UHC Oxford lists S62.367S on its inappropriate primary diagnosis code list.

Pabau’s claims management software supports accurate ICD-10 coding workflows, helping practices reduce claim errors linked to incorrect 7th character selection.

Most fifth metacarpal fractures resolve within six to eight weeks, but the complications that follow can linger far longer. Chronic stiffness, malunion-related pain, and tendon restriction are common sequelae that require their own documentation and billing codes. ICD-10 code S62.367S is the billable code that captures those late-effect complications specifically for a nondisplaced fracture of the neck of the fifth metacarpal bone, left hand. Getting this code right matters: using a subsequent-encounter code (D, G, K, or P) when the fracture has already healed and the patient is presenting with a residual condition is a coding error that can trigger denials.

This reference covers the clinical definition of S62.367S, how the 7th character S differs from D/K/P, the full code hierarchy, related codes in the S62.3 family, documentation requirements, and common CPT pairings for sequela management visits.

ICD-10 code S62.367S: definition and clinical description

The CDC/NCHS ICD-10-CM classification system, which maintains the U.S. clinical modification of ICD codes, places S62.367S within the injury chapter (S00-T88) under fractures at the wrist and hand level (S62). The code breaks down as follows:

• S62 – Fracture at wrist and hand level
• S62.3 – Fracture of other and unspecified metacarpal bone
• S62.36 – Nondisplaced fracture of neck of other metacarpal bone (fifth-specific codes share this sub-category)
• S62.367 – Nondisplaced fracture of neck of fifth metacarpal bone, left hand
• S62.367S – Same as above, sequela (7th character S)

A nondisplaced fracture means the bone fragments remain in normal position despite the fracture line. The neck of the fifth metacarpal is the narrowed segment just nearest to the metacarpal head. Clinicians informally associate this injury pattern with “boxer’s fracture,” though that term more precisely refers to fractures of the fourth or fifth metacarpal neck. For accurate claims management workflows, coders should use the precise code rather than relying on the informal name.

7th character S: what sequela means for coding

The 7th character drives the clinical meaning of S62.367S. Under ICD-10-CM Official Guideline I.C.19, ICD-10-CM defines “sequela” as a condition that arises as a direct result of an injury after the acute phase has ended. The fracture itself is no longer what the provider is treating. Instead, the patient presents with a residual effect.

The key distinction between D/K/P and S: subsequent encounter codes (D, G, K, P) apply while the fracture is still the active diagnosis. Sequela coding in ICD-10-CM applies after healing is complete and the patient’s current complaint is a residual condition such as reduced grip strength, chronic pain at the fracture site, or restricted metacarpophalangeal joint range of motion.

When using ICD-10 code S62.367S, coders must also code the sequela condition itself. The sequela code (S62.367S) identifies the cause; a separate code captures the current condition. For example, a patient presenting with stiffness of the left hand joints following a healed fifth metacarpal neck fracture would require both S62.367S and the appropriate code for the stiffness.

Related codes and the S62.3 family

Understanding where ICD-10 code S62.367S sits within its code family helps prevent laterality and coding errors. The S62.36 sub-category covers nondisplaced fractures of the metacarpal neck for all five metacarpal bones. For the fifth metacarpal specifically, the full 7th-character series is:

• S62.367A – Initial encounter, closed fracture
• S62.367B – Initial encounter, open fracture
• S62.367D – Subsequent encounter, routine healing
• S62.367G – Subsequent encounter, delayed healing
• S62.367K – Subsequent encounter, nonunion
• S62.367P – Subsequent encounter, malunion
• S62.367S – Sequela

The right-hand equivalent is S62.366S. When a patient has bilateral involvement or documentation is ambiguous, coders should query the treating provider rather than default to an unspecified code. Injury code documentation clarity from the provider is the foundation of accurate sequela coding. The sports medicine software and hand-injury specialties that most commonly see this code family benefit from structured documentation templates that prompt laterality and healing status at every encounter.

Billable status and reimbursement notes for S62.367S

ICD-10 code S62.367S is a billable, specific ICD-10-CM code valid for reimbursement purposes. Per CMS ICD-10 coding requirements, claims with a date of service on or after October 1, 2015 must use ICD-10-CM codes. S62.367S meets that requirement as a fully specified 7th-character code.

Billing teams and intake documentation staff should note one payer-specific restriction: UnitedHealthcare Oxford lists S62.367S on its Inappropriate Primary Diagnosis Code List. This reflects the structural nature of sequela codes generally. A sequela code describes the origin of a condition, not the active diagnosis the provider is treating. As a result, S62.367S should function as a secondary code in most claim submissions, paired with the primary code for the current residual condition. Submitting S62.367S as the sole or primary diagnosis code will likely result in rejection from payers with similar policies.

Practices using physiotherapy clinic compliance frameworks should build this coding pattern into their billing workflow: active residual condition code (primary) + S62.367S (secondary, cause).

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Documentation requirements for sequela encounters

Sequela visits for a healed fifth metacarpal fracture require documentation that clearly separates the resolved acute injury from the current complaint. The record should state that the fracture has healed and identify the specific lasting condition bringing the patient in. Vague notes referencing “history of fracture” without naming the active complaint are insufficient to support S62.367S with a paired residual code.

Key documentation elements for S62.367S encounters:

• Confirmation that the original fracture (fifth metacarpal neck, left hand) is healed or resolved
• Description of the residual condition: stiffness, chronic pain, limited range of motion, tendon complication, or grip weakness
• Laterality confirmed as left hand throughout the note
• Treatment plan addressing the sequela (physiotherapy, splinting, pain management, or surgical intervention if applicable)
• CPT procedure code(s) matching the service the provider renders for the residual condition

Structured clinical notes that capture these elements reduce the query burden on coders and support clean first-pass claim submission. Physical therapy practice requirements in many states also mandate documented treatment rationale for continued care of post-fracture sequelae. Practices in hand rehabilitation and physical therapy EMR workflows benefit from templates that auto-prompt healing-status documentation at sequela visits.

CPT codes commonly paired with S62.367S

The sequela diagnosis code S62.367S pairs with procedure codes that address the residual condition being managed. Practices commonly pair S62.367S with evaluation and management codes for established patients (99211-99215), therapeutic procedure codes for hand rehabilitation, and manual therapy codes. The appropriate CPT code depends on the service rendered, not the diagnosis code itself.

Practices should reference the AAPC Codify ICD-10-CM lookup for code-matching guidance and verify that their selected CPT codes align with the documented service. The ICD List reference database also provides code-specific guidance for sequela billing. For workers’ compensation claims where a fifth metacarpal fracture occurred as an occupational injury, the payer will require additional documentation linking the sequela to the workplace incident. Coders should confirm whether the practice submits the claim to a workers’ compensation carrier or a standard health insurer, as primary diagnosis ordering rules may differ. Review HIPAA compliance for medical offices to ensure encounter documentation meets applicable privacy and billing standards.

Conclusion

Sequela coding errors are among the most preventable sources of claim rejection in post-fracture billing. ICD-10 code S62.367S is the correct code when a patient presents with residual complications of a healed nondisplaced fifth metacarpal neck fracture, left hand. Use it as a secondary code paired with the primary code for the active residual condition, confirm laterality and healing status in your documentation, and avoid submitting it as a standalone primary diagnosis.

Practices that embed correct 7th-character logic into their documentation templates and coding workflows catch these errors before submission. Pabau’s claims management tools help clinical teams track encounter type, apply correct diagnosis sequencing, and reduce first-pass denial rates across hand and musculoskeletal injury codes.

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