ICD code S62.397D – Other fracture of fifth metacarpal bone, left hand, subsequent encounter

Key takeaways

S62.397D covers routine-healing follow-up care for an other fracture of the fifth metacarpal bone of the left hand.

The sixth character 7 encodes both the bone and the side, so the code applies only to a left fifth metacarpal fracture.

The D seventh character applies to any visit in the routine healing phase after the initial treatment decision, not only the second visit.

Delayed healing, nonunion and malunion take G, K and P instead of D, and an open fracture at the first visit takes B.

ICD-10 Code S62.397D: Definition and code-at-a-glance

ICD-10 Code S62.397D is a valid, billable ICD-10-CM diagnosis code. Its full official descriptor is “Other fracture of fifth metacarpal bone, left hand, subsequent encounter for fracture with routine healing.”

The code sits in category S62, fracture at wrist and hand level. It is a complete seven-character code, so it is acceptable for claim submission as written.

Code breakdown: Decoding every character of S62.397D

Every character in an ICD-10-CM trauma code carries a specific meaning. So reading them left to right reveals the full clinical story that the payer expects the note to support.

The 5th character (9) and the 6th character (7) answer different questions. First, the 9 places the fracture in the “other fracture” subcategory, outside the base, shaft and neck codes.

The 7, by contrast, names the bone and the side together: the fifth metacarpal of the left hand. As a result, a note that documents the right hand, or a different metacarpal, needs a sibling code instead.

What “other fracture” means for metacarpal bones

The S62.3 metacarpal codes are organized by fracture site and displacement. Subcategories S62.31 through S62.36 cover displaced and nondisplaced fractures of the base, shaft and neck. S62.39, “other fracture of other metacarpal bone,” is the residual subcategory. In other words, the ICD-10-CM Alphabetic Index sends a documented metacarpal fracture there when it fits none of those site codes.

• Base, shaft or neck fracture: Code to S62.31- through S62.36-, depending on the site and whether it is displaced.
• Fracture with no site or type documented: Code to S62.30-, unspecified fracture of other metacarpal bone.
• First metacarpal (thumb) fracture: Code to category S62.2-, which sits outside S62.3 entirely.
• Documented fracture that fits none of these: Code to S62.39-, with the sixth character set by the bone and the side.

However, the code does not capture a fracture where the record describes neither the site nor the fracture type. That record points to S62.30- instead.

For this reason, coders should read the radiology report before choosing between them. If the report places the fracture at the base, shaft or neck, it goes to the site-specific codes. S62.39- then covers what remains.

Understanding the subsequent encounter suffix (D)

The seventh character D denotes a subsequent encounter for a fracture with routine healing, per ICD-10-CM Official Guidelines Section I.C.19.a. In other words, the term “subsequent” refers to the phase of care, not the visit number.

For example, a patient has closed reduction in the emergency department, then returns two weeks later for a cast check. That visit is a subsequent encounter. So is a tenth follow-up X-ray six months into healing, as long as the fracture stays on track.

When to use a seventh character other than D

S62.397 takes the full fracture extension set: A, B, D, G, K, P and S. However, D is only for routine healing. A follow-up visit for delayed healing takes S62.397G, nonunion takes S62.397K, and malunion takes S62.397P.

Similarly, an open fracture at the initial encounter takes S62.397B rather than A. The chart below turns that choice into three questions, asked in order.

S62.397A vs S62.397D vs S62.397S: Choosing the right seventh character

The three seventh-character variants of S62.397 describe the same fracture pattern across three distinct care phases. As a result, the wrong choice is a frequently audited error in the S62.39x group. This is because payers cross-check the encounter date against prior claims for the same patient.

Related and adjacent ICD-10 codes to know

S62.397D is one of ten sibling codes in S62.39-. Its sixth character pins it to the fifth metacarpal of the left hand. So when the note names a different bone or the right hand, use the matching sibling code instead. The table below maps the full S62.39xD family for subsequent encounter visits.

When a physical therapy practice manages the subsequent care, the therapist’s notes should reference the referring diagnosis from the orthopedic note. Linking that diagnosis to the therapy episode keeps one code across the care team. As a result, the ortho claim and the therapy claim match.

Documentation requirements for S62.397D

To support a subsequent encounter claim, the clinical note must establish several facts that payers check on audit. Missing one of them does not automatically cause a denial. However, it weakens the claim and raises the risk of a documentation request.

• Bone and side: Name the fifth metacarpal and the left hand explicitly. The sixth character 7 asserts both. So a note that names a different bone or the right hand contradicts the code.
• Fracture type: Reference the imaging report’s description of the fracture. It should show why the fracture falls in the “other fracture” subcategory, not a base, shaft or neck code.
• Care phase: State explicitly that the initial treatment decision has been made and the visit is for routine follow-up. Progress notes that say “follow-up per treatment plan” or “wound healing satisfactorily” establish the D phase.
• Radiographic findings: Reference the most recent X-ray in the follow-up note, even briefly. This matters because payers increasingly check for an imaging review before they pay for fracture aftercare.
• Healing status: State whether healing is routine. Delayed healing, nonunion and malunion move the seventh character to G, K or P, so the note must support D.

Understanding medical billing workflows end to end also helps practices build documentation habits that prevent audit requests. For example, with one shared checklist for aftercare visits, the note usually holds what the payer needs.

Payer requirements and prior authorization considerations

Coverage policies for metacarpal fracture follow-up visits vary by payer. Medicare generally covers orthopedic fracture aftercare visits without prior authorization. However, commercial plans and workers’ compensation programs often apply different rules.

Therefore, always verify coverage specifics against the payer’s local coverage determination (LCD) or benefit plan language before billing.

• Medicare: Part B covers follow-up visits for fracture aftercare billed with S62.397D when the note documents medical necessity. E/M visits and cast management typically need no prior auth.
• Commercial insurers: Some plans require a referral from the primary care provider for specialist orthopedic follow-up. Others apply visit limits to outpatient fracture management. Verify the patient’s specific plan.
• Workers’ compensation: Workers’ comp plans are jurisdiction-specific. The injury mechanism, employer-filed first report of injury, and treating-provider authorization must all align. Otherwise, S62.397D on a workers’ comp claim without matching injury documentation is a common audit trigger.
• Prior authorization triggers: Most commercial plans require prior authorization for surgical fixation and advanced imaging. Many also require it for hand therapy and for durable medical equipment such as custom splints.

Maintaining medical billing compliance for fracture aftercare means mapping each payer’s auth rules at the practice level. A single universal rule will not hold. After all, payer policies update every year, so last year’s auth rule may no longer apply.

Common claim denial reasons for S62.397D

The five denial patterns below come up most often on S62.397D claims. Fortunately, each has a straightforward fix.

• Using A instead of D for follow-up visits: This is the most common error across the S62.39x family. If the patient already has a claim for this fracture under S62.397A, the payer flags a second A claim as a duplicate. Instead, switch to D at every visit after the initial treatment decision.
• Using S62.397D for the wrong bone or side: S62.397D applies only to the fifth metacarpal of the left hand. Billing it for a right-hand fracture, or for a second, third or fourth metacarpal, is a coding error. So confirm both the fifth metacarpal and the left hand in the note before submitting.
• Using D when healing is not routine: Delayed healing, nonunion and malunion take G, K and P instead. As a result, a D claim with a note that describes nonunion invites a query on audit.
• CPT/ICD mismatch: A casting or splinting CPT code (29085, 29086) billed with a fracture aftercare ICD-10 code must describe consistent services. For example, a casting code without a fracture diagnosis raises a medical necessity flag. So does a fracture aftercare code without a service that reflects ongoing fracture management.
• No radiology reference in the note: Payers for fracture follow-up increasingly expect proof of an imaging review. So a note that skips a recent X-ray or the healing status is vulnerable to denial on audit.

How to prevent S62.397D denials

Effective denial management in healthcare for hand fracture visits starts before submission. In practice, a pre-submission review catches most S62.397D denials at the front door. First, it checks the seventh character. Then it confirms the bone and side in the note and matches the CPT code to the service.

A working knowledge of denial codes helps the billing team sort rejected S62.397D claims quickly. The team can then correct them before they age into write-offs.

CPT codes commonly paired with S62.397D

At a subsequent encounter, the procedure codes billed with S62.397D reflect the aftercare services, not the original fracture treatment. By contrast, initial fracture-treatment codes such as 26600 and 26615 pair with S62.397A or S62.397B, not with the subsequent encounter code.

However, if the same provider billed a fracture-care code, its 90-day global period already includes routine follow-up visits. So report them with 99024, not a separate E/M code.

How Pabau supports S62.397D aftercare claims

Fracture aftercare claims usually fail on small details. For example, a seventh character carries over from the acute visit, or the claim’s side does not match the note. Each is easy to catch before submission but slow to fix after a denial.

Practice management software like Pabau keeps the clinical note and the claim in one system. As a result, the billing team codes from the record itself. Pabau’s claims management software handles submission, eligibility checks, claim status and remittance posting in that same place.

Claims go out through the Claim.MD clearinghouse, our US partner, which reaches thousands of US payers. In addition, eligibility responses and electronic remittance advice come back against the same patient record. The goal is a clean claim on the first submission, with the seventh character and side already confirmed against the note.

Manage fracture follow-up billing without the guesswork

Pabau’s claims management software submits claims through the Claim.MD clearinghouse, checks patient eligibility, and posts remittances against the patient record. See how it handles fracture aftercare billing.

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Conclusion

Getting S62.397D right comes down to three checks. The note names the fifth metacarpal of the left hand, the fracture belongs in the “other fracture” subcategory, and healing is routine. Each check maps to a character in the code. So any auditor can spot a mismatch between note and claim.

That makes most S62.397D denials avoidable, because the chart already holds the facts the code needs. The remaining work is making sure the claim says what the note says, at every visit. Book a demo to see how Pabau keeps fracture aftercare notes and claims in one workflow.

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Frequently asked questions

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