ICD code S62.628G – Displaced middle phalanx fracture, delayed healing

Key takeaways

S62.628G is a billable ICD-10-CM code, valid for FY2026, for a displaced middle phalanx fracture at a follow-up visit where healing is delayed.

Other finger means the record names the digit but not the hand, so a documented side moves the claim to S62.620G–S62.627G.

The 7th character G means delayed healing. Confusing it with routine healing (D) or nonunion (K) is a common denial trigger for this code.

Documentation must confirm displacement on imaging, name the digit, and record delayed healing at a follow-up visit.

Practice management software like Pabau keeps imaging, treatment notes and claims on one patient record, so coders can check each character before submission.

ICD-10 code S62.628G at a glance

ICD-10 code S62.628G is the billable code for a displaced middle phalanx fracture of “other finger” at a follow-up visit with delayed healing. “Other finger” means the note names the digit but not the hand it is on. The table below gives the core facts to check before you open a chart.

What does S62.628G mean? Breaking down each code segment

S62.628G describes a displaced middle phalanx fracture of a named finger whose side isn’t documented. It applies at a follow-up visit where healing has been delayed. Each segment carries a specific clinical meaning that must match the documented record.

The middle phalanx is the middle bone in a finger. It sits between the proximal phalanx, nearest the hand, and the distal phalanx at the fingertip. The thumb has no middle phalanx, so thumb fractures never land in this code group.

A displaced fracture means the bone ends have shifted out of normal alignment. Displaced is also the default when documentation doesn’t state displacement status, per ICD-10-CM Official Guidelines Section I.C.19.

What does “other finger” mean in S62.628G?

“Other finger” in S62.628G means the record names the fractured digit but doesn’t say which hand it is on. The ICD-10-CM tabular list files this under the inclusion term “specified finger with unspecified laterality.” Every digit with a documented side has its own code inside S62.62.

Codes inside S62.62, by digit and side:

• Index finger — S62.620 (right) or S62.621 (left)
• Middle finger — S62.622 (right) or S62.623 (left)
• Ring finger — S62.624 (right) or S62.625 (left)
• Little finger — S62.626 (right) or S62.627 (left)
• Named finger, side not documented — S62.628 (other finger)
• Finger not named — S62.629 (unspecified finger)

Fractures coded outside S62.62:

• Thumb — coded under the S62.5- series, since the thumb has no middle phalanx
• Nondisplaced middle phalanx fractures — category S62.65, where the index finger is S62.650 (right) or S62.651 (left)

Two checks settle whether S62.628G is the right code, and the chart below walks through both.

Query the provider for laterality before you bill. “Ring finger fracture, delayed union” supports S62.628G, but “right ring finger” moves the claim to S62.624G. Both the digit and the side belong in the clinical note or operative report.

Understanding the 7th character G: Subsequent encounter types compared

The 7th character G denotes a subsequent encounter for a fracture with delayed healing. The fracture hasn’t progressed to union at the expected clinical rate. It differs from routine healing (D) and from nonunion (K), and that distinction drives many coding errors on fracture follow-up claims.

Initial encounter characters apply to every visit while the patient receives active treatment for the acute injury. In category S62, that means A for a closed fracture and B for an open one. Once the patient moves into follow-up, D, G, K and P take over, and S marks a sequela.

The key clinical distinction between G and D is documented healing progress. For G, the provider must note that the fracture isn’t progressing as expected for the time since injury, supported by radiographic findings. Without that note, a payer may reclassify the visit as routine healing (D), which can affect coverage for certain interventions.

S62.628G vs related codes: Avoiding common coding errors

The codes most often confused with S62.628G differ by encounter type, displacement status, bone, or finger specificity. Picking the wrong neighbor on a follow-up claim is a frequent error in orthopedic billing audits.

Clinical documentation requirements for S62.628G

Payer medical necessity reviews for S62.628G focus on five documentation elements. Missing any one of them is enough for a denial or a post-payment audit recovery demand.

• Displaced fracture confirmed on imaging: The radiology report must describe displacement. A report stating “fracture present” without noting displacement doesn’t support S62.628 on its own. If the original imaging isn’t available at follow-up, reference the initial report by date in the clinical note.
• Digit named, with the side confirmed or queried: The clinical note must name the digit, such as “ring finger” or “small finger.” S62.628G fits only when the hand isn’t recorded, so query the provider for laterality first. A documented side moves the claim to S62.620G–S62.627G.
• Visit confirmed as a subsequent (follow-up) encounter: The note must show the patient is in follow-up for an existing injury, not a new one. A reference to prior treatment dates or prior imaging helps.
• Delayed healing documented and supported: The provider must state that healing is slower than expected for the elapsed time. The radiology report must reflect this too. Phrases such as “inadequate callus formation for 8 weeks post-injury” or “delayed union, ongoing monitoring” are appropriate.
• Treating provider signature and date: Required on all supporting documentation for fracture follow-up claims. Most payers accept electronic signatures with date and time stamps.

Radiology reports are the most audited document for this code. Keep imaging results in the chart with a direct reference in the clinical note, rather than as a separate attachment that reviewers may overlook.

CPT codes commonly billed with ICD-10 code S62.628G

The CPT-ICD pairings below are typical for delayed-healing fracture follow-up, and some attract closer scrutiny than others. The table reflects standard orthopedic practice, but payer LCDs vary and always take precedence over general guidance.

A delayed-healing follow-up billed outside a global period usually goes out as an established-patient visit, most often 99213. A clearinghouse catches CPT-ICD pairing mismatches before they reach the payer. Its edits flag combinations known to generate denials under Medicare and major commercial policies.

Common claim denial reasons for S62.628G

Familiarity with medical billing denial codes makes it easier to trace which element of the S62.628G claim failed. The denial reasons below are specific to this code and carry corrective actions.

• Wrong 7th character (D used instead of G): The most frequent error, because D (routine healing) and G (delayed healing) are easily transposed. Corrective action: add delayed-healing documentation to the chart, resubmit with the corrected code, and attach the imaging report.
• Displacement status not documented: If the record doesn’t confirm a displaced fracture, the payer may reject S62.628 in favor of S62.658 (nondisplaced). Corrective action: reference the original imaging report in the clinical note and obtain an addendum if needed.
• Finger or side not specified: “Finger fracture” without naming the digit points to S62.629G, and payers often hold it. Corrective action: amend the note to name the digit and, where known, the hand. Then resubmit with the matching code.
• Use of S62.628G on an initial encounter visit: G applies only to follow-up visits, so using it at first contact creates a logic conflict. Corrective action: verify the encounter type from the note and resubmit with S62.628A if the visit was an initial encounter.
• Insufficient imaging to support “delayed healing”: Without a radiology report or provider narrative describing delayed progress, the G designation has no clinical basis. Corrective action: obtain the imaging report and have the provider document the delayed healing finding explicitly.
• CPT-ICD pairing mismatch: A surgical CPT code paired with a subsequent encounter ICD-10 code, without pre-authorization documentation, can generate a medical necessity denial. Corrective action: confirm prior authorization was obtained and attach the authorization number to the resubmission.

Routing claims through a clearinghouse adds eligibility checks and payer-specific edits. Those edits catch 7th character mismatches and CPT-ICD conflicts before the claim leaves the practice, which is far cheaper than correcting a denial afterward.

Payer-specific coverage notes for S62.628G

Coverage policies for fracture follow-up care with delayed healing vary by payer. The following is general guidance only, and individual payer LCDs and benefit policies always control.

Claims tools that track payer-specific rules can alert billing staff before submission when a code combination falls outside a payer’s coverage criteria.

• Medicare: Covers medically necessary follow-up care for displaced finger fractures under musculoskeletal policy. The delayed healing designation (G) requires documentation that healing hasn’t progressed at the expected rate. There’s no national coverage determination for finger fractures, and MAC policies vary, so check your MAC’s LCD database.
• Medicaid: Coverage varies significantly by state. Most states cover fracture follow-up as medically necessary, and some require prior authorization for surgical CPT codes billed alongside subsequent encounter diagnoses. Verify with the state Medicaid program or managed care organization.
• Commercial payers: Most major commercial payers cover follow-up care for fracture delayed healing when medical necessity is documented. Prior authorization is typically required for surgical interventions (CPT 26725, 26735) at subsequent visits. Some payers require the radiology report to be submitted with the claim.
• Workers’ compensation: Follow-up fracture care under workers’ comp requires the injury to be related to a workplace incident. Delayed healing documentation must include the treating physician’s clinical assessment and an updated prognosis for return to work.

ICD-10-CM official coding guidelines relevant to S62.628G

The CDC/NCHS ICD-10-CM official code tool and the Official Guidelines for Coding and Reporting, Section I.C.19, govern how S62 fracture codes are assigned. Key provisions relevant to S62.628G include the following.

• Displaced is the default: When documentation doesn’t specify whether a fracture is displaced or nondisplaced, the Guidelines direct coders to default to displaced. So S62.628 (displaced) is correct when the record is silent on displacement status, not S62.658 (nondisplaced).
• 7th character assignment follows the encounter type: The 7th character is determined by the type of encounter, not by who provides the care. A physical therapist seeing a patient for a delayed-healing fracture still supports G if the treating orthopedic provider has documented delayed healing.
• Subsequent encounter begins after active treatment ends: Once the acute treatment episode ends, follow-up visits use a subsequent encounter 7th character. That point usually comes after the initial manipulation and immobilization. The move from A to D, G, K, or P is a clinical decision, not a time-based cutoff.
• Delayed healing vs nonunion is a clinical determination: The Guidelines don’t define a timeframe for when delayed healing becomes nonunion. The treating provider decides, based on imaging and clinical assessment. Coders must not make this call independently and should query the provider when documentation is ambiguous.

Fracture follow-up documentation also has to meet HIPAA transaction and code set standards, so review the billing compliance rules for your practice type.

The AAPC ICD-10-CM code lookup is a useful cross-reference for code hierarchy and the 7th characters available in the S62 category. For annual code validity, the authoritative source is the CMS ICD-10 codes page.

How claims management software prevents S62.628G denials

Many S62.628G denials trace back to a single character. A coder picks D instead of G, or the claim goes out with a named finger, no side and no query on file. Those errors usually surface weeks later as a denial or an audit request.

Practice management software like Pabau keeps the imaging report, the follow-up note and the claim on one patient record. Coders can confirm the digit, the side and the healing status before choosing the sixth and seventh characters. Claims then go out through Pabau’s software for billing teams, which connects to the Claim.MD clearinghouse for payer-specific edits.

The result is fewer resubmissions on fracture follow-ups, plus an audit trail showing why each character was chosen.

Reduce claim denials on fracture follow-up codes

Pabau’s claims management tools help orthopedic and hand surgery practices track 7th character assignments across fracture encounters. Documentation is checked before submission, and claims route through Claim.MD’s clearinghouse for payer edits.

Book a demo

Conclusion

S62.628G is a narrow code, and the narrowness is the point. Before you bill it, confirm two facts in the chart. The note names a finger without its side, and imaging shows delayed healing.

If the side is recorded, a sibling code is more accurate. If the healing status is unclear, a provider query protects the claim better than a guess. The trade-off is a short delay on submission against a denial that can take weeks to overturn.

Book a demo to see how Pabau keeps imaging, notes and follow-up claims on one record, so coders pick the right character first time.

Continue your research

Need to understand how denial codes affect fracture billing? Denial codes in medical billing covers the CARC and RARC codes most commonly returned on musculoskeletal claims.

Want to build a cleaner claim submission workflow? Building a clean claim explains what payers check before adjudicating and how to reduce pre-submission errors.

Coding a finger fracture that failed to unite? ICD-10 code S62.630K covers a displaced distal phalanx fracture of the right index finger at a nonunion follow-up.

Frequently asked questions