ICD-10 code S82.016B: Patella Fracture Coding Guide

Key takeaways

ICD-10 code S82.016B is billable for a nondisplaced osteochondral fracture of the unspecified patella.

It applies only at the initial encounter for an open fracture graded Gustilo type I or type II.

The 7th character B is what makes the code billable. Parent code S82.016 is not billable on its own.

Laterality is unspecified here. Use S82.014xB for the right patella or S82.015xB for the left when the record names a side.

Practice management software like Pabau keeps operative notes, consent, and encounter details on one patient record, so coders find the detail fast.

ICD-10 code S82.016B: definition and billable status

ICD-10 code S82.016B is a billable ICD-10-CM diagnosis code for a nondisplaced osteochondral fracture of the unspecified patella. Specifically, it applies at the initial encounter for an open fracture graded Gustilo type I or type II. As of fiscal year 2026, the code remains valid per the CMS ICD-10-CM code tables and guidelines.

The parent code S82.016 is non-billable on its own. Instead, a 7th character extension is what makes it billable. Specifically, S82.016 accepts the full 16-character extension set used across the S82 fracture category. Within that set, the B extension locks in both the open-wound encounter type and the Gustilo grade.

The most common billing error on this code is submitting the non-extended parent. In turn, recording the encounter type in the patient record at the point of care is what prevents it. Claims management software then pulls that detail straight into the claim.

Code hierarchy and description breakdown for S82.016B

Understanding where S82.016B sits in the ICD-10-CM tabular hierarchy helps coders confirm they are at the correct level of specificity before billing.

The code falls under section S80-S89, which covers injuries to the knee and lower leg. As a result, physical therapy practices meet this code family often, in the documentation handed over from acute orthopedic settings.

Clinical meaning: nondisplaced osteochondral fracture of the patella

An osteochondral fracture involves both the subchondral bone and the overlying articular cartilage of the patella (kneecap). In this context, the “nondisplaced” qualifier means the fracture fragments have not shifted out of their normal anatomical alignment.

These injuries are clinically associated with acute patellar dislocation and high-impact direct trauma to the front of the knee. When the kneecap dislocates laterally, shear forces can lift an osteochondral fragment off the medial patellar facet or the lateral femoral condyle.

• Displacement status: Nondisplaced means bone ends remain in anatomical position. In contrast, displaced fractures are coded separately under S82.011 (right patella) or S82.012 (left patella) families.
• Tissue involved: Both bone (osseous layer) and articular cartilage are disrupted. However, pure cartilage lesions without bone involvement are not captured by S82.016B.
• Laterality: S82.016B specifies the unspecified patella. However, when the operative or diagnostic note documents right or left laterality, use S82.014xB or S82.015xB instead.
• Common mechanism: Patellar dislocation, direct knee impact, or pivot-and-fall injuries. In every case, clinical assessment is required to confirm the osteochondral component.

Sports medicine practices handling a high volume of acute knee injuries should capture displacement status, laterality, and wound classification at the initial assessment. As a result, documenting all three up front removes the need for an addendum once the claim goes out.

Understanding the 7th character B: open fracture type I or II

The 7th character B in ICD-10 code S82.016B carries two meanings, and both have to hold. Specifically, the encounter must be the initial one, and the open fracture must be graded Gustilo type I or type II.

Gustilo classification: open fracture types explained

The Gustilo-Anderson classification grades open fractures by wound size, contamination level, and soft-tissue involvement. It was first published in the Journal of Bone and Joint Surgery. Today, ICD-10-CM uses it to assign 7th characters B and C.

The treating physician or surgeon must document the Gustilo type in the operative or emergency note. Accordingly, coders cannot assign Gustilo grade independently based on wound description alone. If physician documentation does not specify the grade, query the provider before submitting the claim.

All valid S82.016 7th character extensions

S82.016 requires a 7th character to be billable. Together, the complete set of valid extensions covers every encounter type from initial presentation through to sequela. For example, a sequela code such as S81.009S shows how the final S extension reads in practice.

The CDC/NCHS ICD-10-CM web tool carries the official FY2026 tabular list. Accordingly, use it to confirm the valid extensions for S82.016 and for neighboring S82 codes such as S82.121Q. Notably, the characters I and O are left out of ICD-10-CM fracture codes to avoid confusion with the numerals 1 and 0.

Related and sibling patella fracture codes

S82.016B sits within a larger family of patellar fracture codes. Therefore, knowing the sibling and adjacent codes prevents miscoding when laterality is documented or when the fracture type differs.

The AAPC ICD-10-CM code lookup lists the full S82.0 family with billability indicators. From there, use it to cross-reference the right sibling when laterality or fracture type changes between encounters.

CPT code crosswalk for patellar fracture repair

ICD-10-CM S82.016B is a diagnosis code only, and it carries no payment rate of its own. Instead, the treatment is billed separately with the CPT code that matches what was performed. Treat the crosswalk below as advisory. Accordingly, verify every pairing against current payer policy and the AAPC CPT-to-ICD-10 crosswalk tool before submission.

Verify CPT pairings for patellar fracture repair against the AMA CPT codebook before billing. Additionally, payer policies on bundling, modifiers, and medical necessity criteria vary. As a result, a claim that pairs an open-fracture diagnosis with a closed-treatment procedure code will not survive review.

Documentation requirements for S82.016B

Accurate documentation is what makes an S82.016B claim defensible. Specifically, the clinical record has to support every element of the code, from fracture type through to encounter type.

• Fracture type: Documentation must state “osteochondral fracture” or describe involvement of both bone and articular cartilage. Otherwise, “Patellar fracture” alone is insufficient for the osteochondral specificity.
• Displacement status: The note must specify “nondisplaced.” If displacement status is absent, query the provider. Above all, never default to nondisplaced without documentation.
• Open wound confirmation: The emergency or operative note must describe a skin breach that communicates with the fracture site. However, a wound noted nearby is not enough on its own.
• Gustilo type I or II classification: The treating physician must document the Gustilo grade. Instead, coders cannot infer grade from wound size alone. If the note says “small open wound” without a Gustilo type, query before coding.
• Laterality: If the record specifies right or left knee, do not use S82.016B. Instead, use S82.014xB for the right patella or S82.015xB for the left.
• Encounter type: The visit must be the initial encounter (active treatment, not just follow-up of a previously diagnosed fracture). By contrast, subsequent visits use D-S extensions depending on healing status.

Practices using digital documentation forms can build these fields into standard intake and assessment templates. Each data point is then captured at the encounter rather than chased weeks later. In turn, standardized medical forms cut the coding queries and claim delays that follow a thin note.

Coding guidelines and common errors for S82.016B

The ICD-10-CM Official Guidelines for Coding and Reporting govern how fracture codes in the S80-S89 range are assigned. Together, those guidelines are approved jointly by CMS, NCHS, AHA, and AHIMA. In practice, three patterns account for most S82.016B errors.

Error 1: using the non-billable parent code

Submitting S82.016 (without any 7th character) as a standalone claim code is the most common error. Indeed, S82.016 is non-billable. Consequently, every claim must use the fully extended version (S82.016A through S82.016S). As a result, many clearinghouses will reject non-extended fracture codes outright.

Error 2: mismatching encounter type to healing status

Using 7th character B on a third or fourth follow-up visit is a sequencing error. Specifically, B applies only while the patient is in active treatment for the fracture. Once the patient is seen for aftercare or complication management, a subsequent encounter extension is required.

Coding compliance programs should audit fracture encounter-type assignments periodically to catch this pattern.

Error 3: coding B when the Gustilo grade is type III

Using B on a Gustilo type IIIA, IIIB, or IIIC wound understates the severity of the injury. Those wounds take 7th character C instead. As a result, coding them as B can produce a medical necessity denial or an audit flag.

When documentation is ambiguous, query before coding. Similarly, type III wounds carry their own extension letters right across the S-chapter, as in S52.242J.

When to seek specialist input on coding S82.016B

Most S82.016B claims are straightforward once the documentation is complete. However, a subset of cases benefit from escalation to a physician advisor or certified clinical documentation specialist (CCDS).

• Gustilo grade not documented: The physician note describes an open wound but does not state the Gustilo type. A coder cannot assign B (type I/II) or C (type III) without physician confirmation. Therefore, a formal query is required.
• Osteochondral injury not explicitly named: The radiologist or surgeon describes a “patellar fracture with chondral involvement” without using the term “osteochondral.” In that case, query whether the documentation supports the osteochondral specificity of S82.016B versus a less specific patellar fracture code.
• Nonunion or malunion at a subsequent visit: Once the fracture progresses to nonunion or malunion, the 7th character changes. M covers type I/II nonunion and Q covers type I/II malunion, while K covers the closed-fracture parallel, as in S52.209K. In turn, a CCDS review keeps the healing complication documented clearly enough to support these extensions.
• Complex multi-trauma cases: When patellar fracture accompanies ligamentous injury, distal femur fracture, or vascular repair, sequencing gets harder. In these cases, principal diagnosis selection needs physician advisor input, so the most resource-intensive condition is the one reported.

Patient compliance documentation in post-fracture rehabilitation also affects coding continuity across encounters. Consequently, practices with solid documentation workflows can support the changing 7th character through the full episode of care.

How Pabau keeps patellar fracture documentation claim-ready

In most orthopedic practices the detail behind S82.016B lives in three places. Specifically, the operative note sits in one system, the consent and intake forms in another, and the wound photographs on somebody’s phone. As a result, pulling one claim together means chasing all three.

Practice management software like Pabau keeps them on the same patient record. Specifically, the operative note, the Gustilo grade captured on a custom form, and the wound photos all sit against the encounter. When a coder opens the record, the detail that supports the 7th character is already there.

Pabau then pulls what is already on that record into a pre-filled claim and submits it, so nobody retypes a diagnosis code. As a result, queries drop, and the practice stops losing days to addenda.

Keep fracture documentation claim-ready

Pabau brings operative notes, consent forms, and encounter details onto one patient record, then pulls that detail into a pre-filled claim. Your coders stop chasing the Gustilo grade and laterality after the fact.

Book a demo

Conclusion

Three things sink patellar fracture claims. Namely, the 7th character is missing, the encounter type no longer matches the visit, or nobody wrote down the Gustilo grade. In short, S82.016B is billable only when the record confirms all three elements.

All three start in the note and only surface at the claim stage, weeks after the patient has left. By then the fix costs a provider query and a delayed payment.

So build the Gustilo grade, the displacement status, and the laterality into the assessment form your team fills in at the first visit. Book a demo to see how Pabau keeps that detail on the record and ready for the claim.

Continue your research

Coding a superficial lower-leg wound rather than a fracture? S80.812A covers the abrasion codes and the initial-encounter rules that sit alongside them.

Need the subsequent-encounter rules for a growth-plate fracture? S49.032D shows how the D extension works once routine healing is documented.

Coding an injury the patient was treated for years ago? S12.14XS walks through sequela coding and the X placeholder in the same S-chapter structure.

Working with an unspecified bone diagnosis instead of a named fracture? M89.9 explains when an unspecified bone disorder code is defensible.

Pairing a fracture diagnosis with a closed-treatment procedure code? CPT code 23605 sets out how closed treatment with manipulation is documented and billed.

Frequently asked questions