ICD-10 code S82.026P: Nondisplaced longitudinal fracture of patella, subsequent encounter for closed fracture with malunion

Key takeaways

ICD-10 code S82.026P describes a nondisplaced longitudinal fracture of the patella coded at a subsequent encounter, where the closed fracture healed with malunion.

S82.026P is fully billable and HIPAA-valid. Its parent, S82.026, is non-billable and needs a 7th character before you can submit a claim.

The 7th character P means closed fracture with malunion. Open-fracture malunion uses Q for type I or II, and R for type IIIA, IIIB, or IIIC.

Practice management software like Pabau helps orthopedic and physical therapy teams apply the right 7th character. It also flags missing documentation before a claim is denied.

S82.026P is a billable ICD-10-CM diagnosis code valid for HIPAA-covered transactions. According to the CDC/NCHS ICD-10-CM web tool, the full clinical description reads: Nondisplaced longitudinal fracture of unspecified patella, subsequent encounter for closed fracture with malunion.

The parent code S82.026 cannot be submitted on a claim without a 7th character extension. S82.026P is one of 16 billable child codes that complete the parent. Always verify billable status against the current fiscal year’s ICD-10-CM release, since the CMS ICD-10 codes page publishes annual updates that can affect validity.

P and R are easy to transpose in this code family, and the two are not interchangeable. P covers closed fractures only. R covers the most severe open fractures, Gustilo types IIIA, IIIB, and IIIC. The extension table below separates all 16 characters so you can check the one you are about to submit.

What S82.026P means: Breaking down the code

Each segment of ICD-10 code S82.026P carries a specific clinical meaning. Reading the code from left to right reveals the full diagnostic picture without needing a lookup table.

• S82 – Fracture of lower leg, including ankle. This is the block covering injuries from the knee to the ankle.
• S82.0 – Fracture of patella. Narrows the site to the kneecap specifically.
• S82.02 – Longitudinal fracture of patella. Indicates a fracture line running parallel to the long axis of the patella.
• S82.026 – Nondisplaced longitudinal fracture of unspecified patella. The fragments have not separated or shifted, and laterality is not documented.
• P (7th character) – Subsequent encounter for closed fracture with malunion. The patient is past active treatment for the acute injury, and the fracture healed in a malaligned position.

A nondisplaced fracture means the fracture line is present but the bone fragments remain in anatomical alignment. This matters clinically because nondisplaced patella fractures are usually managed conservatively, with immobilization and protected weight-bearing rather than surgery.

The complication captured by code S82.026P is that the fracture healed improperly despite that starting alignment, producing a malunion. For ICD-10-CM coding purposes, the record must document both the nondisplaced pattern and the malunion outcome. Without both on file, a more general patella fracture code is the right choice.

Understanding the 7th character ‘P’ in ICD-10 fracture codes

The 7th character is the most consequential part of any S82 fracture code. It encodes the encounter type and, for several characters, the healing outcome as well. Getting it wrong is a leading source of fracture-code claim denials.

All valid 7th character extensions for S82.026

S82.026 has 16 valid 7th character extensions, and every one of them is billable. The table below lists each child code, what it describes, and the encounter type it represents.

S82.026P is highlighted because it is the subject of this reference. The extension set runs from A to S, but the letters I, L, and O are never used. That is why the sequence steps from H to J, from K to M, and from N to P.

Malunion itself splits three ways in this family. P covers closed fractures, Q covers open type I or II, and R covers open type IIIA, IIIB, or IIIC. Choose between them on the documented wound status of the original injury, not on the severity of the malunion. The same split runs through the femur codes, including S72.414P.

Clinical context: Nondisplaced patella fractures and malunion

The patella is the small, shield-shaped bone at the front of the knee joint. It protects the knee and gives the quadriceps muscle a mechanical advantage during knee extension. Nondisplaced patella fractures most often follow a direct blow to the knee or an eccentric quadriceps contraction, such as a fall onto a flexed knee.

Because the fragments stay aligned in a nondisplaced fracture, conservative management is standard. The limb is immobilized in extension for four to six weeks, followed by progressive rehabilitation. Physical therapy practices managing patella fracture recovery can reference a structured return-to-running rehabilitation protocol for post-fracture functional restoration.

Orthopedic and sports medicine practice software can link encounter documentation directly to the coding workflow. That connection reduces the risk of reusing the initial encounter character (A) at follow-up visits.

Malunion occurs when the fracture heals but the bone consolidates in a position that deviates from normal anatomy. In the patella, that can produce altered patellar tracking, anterior knee pain, and reduced quadriceps strength. Radiographic confirmation of malunion is normally required in the clinical note before ICD-10 code S82.026P can be applied at billing.

When to use S82.026P: Subsequent encounter with malunion

Applying ICD-10 code S82.026P correctly depends on meeting four criteria at the same encounter:

1. The fracture is a nondisplaced longitudinal patella fracture. If the original injury was displaced, or the pattern was transverse or comminuted rather than longitudinal, a different S82 code applies.
2. The encounter is subsequent, not initial. The ICD-10-CM Official Guidelines define subsequent encounters as visits during the healing or recovery phase, after active treatment of the acute injury has concluded. If the patient is still receiving active definitive treatment, the initial encounter character (A) applies even at a later visit.
3. The original fracture was closed. If the injury broke the skin, code the open-fracture malunion character instead. Use Q for Gustilo type I or II, and R for type IIIA, IIIB, or IIIC.
4. The fracture has healed with malunion. Malunion is documented radiographically, with the fracture consolidated but in malalignment. That is distinct from delayed healing (G), where healing is slow but still progressing. It is also distinct from nonunion (K), where healing has failed and no bridging callus is present.

Malunion vs. nonunion vs. delayed healing in ICD-10 coding

These three outcomes are the most commonly confused in fracture coding. Each maps to its own set of 7th characters, and each needs different supporting documentation. The character you pick depends on both the outcome and the wound status of the original fracture.

The critical distinction between malunion (P) and nonunion (K) is that malunion means the bone has healed, just incorrectly. Nonunion means healing has not occurred at all.

Submitting P when the record documents only absent union, without confirming malalignment, is a coding error. Using D when malunion is documented understates the complication and can affect prior authorization for corrective procedures.

Code hierarchy and parent codes

Knowing where ICD-10 code S82.026P sits in the ICD-10-CM tabular hierarchy helps coders navigate to related codes quickly. It also confirms that the required level of specificity has been captured.

• S00-T88: Injury, poisoning and certain other consequences of external causes
• S80-S89: Injuries to the knee and lower leg
• S82: Fracture of lower leg, including ankle
• S82.0: Fracture of patella
• S82.02: Longitudinal fracture of patella
• S82.026: Nondisplaced longitudinal fracture of unspecified patella (non-billable parent)
• S82.026P: Nondisplaced longitudinal fracture of unspecified patella, subsequent encounter for closed fracture with malunion (billable)

The WHO’s ICD-10 classification structures codes hierarchically, so each level adds clinical specificity. For U.S. billing, always work from the ICD-10-CM tabular list rather than the base WHO system. The same chapter, block, category, subcategory, and 7th character logic repeats across every injury category.

Related ICD-10 codes for patella fracture coding

S82.026P sits within a family of S82.02x codes covering every longitudinal patella fracture variant, alongside the broader S82.0 family for other fracture patterns. Accurate patella fracture coding means selecting the right displacement status and fracture pattern before you apply the 7th character.

When laterality is documented in the operative or clinical note, do not fall back on the unspecified S82.026. Code S82.024 for the right patella or S82.025 for the left. Payers increasingly flag unspecified laterality codes for edit review, particularly for musculoskeletal injury billing. Document the affected side in every encounter note to support the more specific code.

Billing and documentation requirements

Four documentation elements must be present in the clinical record before ICD-10 code S82.026P can be submitted:

• Original fracture confirmation: A prior record establishing the nondisplaced longitudinal patella fracture diagnosis, either by imaging report or treating clinician documentation.
• Closed wound status: Confirmation that the original fracture was closed. An open injury moves the code to S82.026Q or S82.026R depending on the Gustilo type.
• Subsequent encounter context: A clear indication that this visit is follow-up rather than active treatment of the acute injury. The note should place the patient in the healing or recovery phase.
• Malunion confirmation: Radiographic evidence of a healed fracture in malalignment. The imaging report or clinician interpretation should describe the malunion explicitly. Wording such as “healed fracture” with no comment on alignment does not support S82.026P over S82.026D.

POA (Present on Admission) exempt status likely applies to S82.026P. Subsequent encounter codes are generally exempt from the POA indicator requirement under current CMS ICD code lists. Verify this against the active fiscal year’s CMS POA exempt list before submission, because exemptions change with annual updates.

Practices using claims management software can configure code-level documentation checklists. Clinicians are then prompted to address encounter type, wound status, fracture pattern, and healing outcome in every note. That cuts back-office rework and supports clean claim submission on the first pass.

Accurate patient record documentation across the whole fracture episode also matters at audit. A subsequent encounter claim is only as strong as the initial encounter record sitting behind it.

Official ICD-10-CM guidelines for fracture encounters

Chapter 19 of the ICD-10-CM Official Guidelines for Coding and Reporting governs how fractures are coded across an episode of care. Three of its rules decide most S82.026P submissions.

• Aftercare Z codes do not apply to injuries. For fracture follow-up, report the acute injury code with the appropriate subsequent encounter 7th character instead of an aftercare Z code.
• The 7th character follows the care delivered, not the calendar. Active definitive treatment takes an initial encounter character. Care during healing or recovery takes a subsequent encounter character, however long ago the injury happened.
• Malunion is a healing complication, not a sequela. Use P while the malunion is being evaluated or treated. Reserve the sequela character S for a residual condition that persists after the healing phase has ended, as in S61.314S.

The guidelines are republished with the tabular list each fiscal year, effective October 1. Reviewing the Chapter 19 fracture section before your practice’s annual coding refresh is the cheapest way to catch a rule change.

CPT codes commonly used with S82.026P

This section covers common CPT procedure pairings for orthopedic and physical therapy encounters coded with S82.026P. CPT selection depends on the services performed at the encounter. The pairings below are for reference and should not be submitted without clinical justification.

For physical therapy practice management, confirm coverage and authorization requirements with each payer before submission.

The AAPC Codify ICD-10-CM lookup tool provides CPT-to-ICD-10 crosswalk references that help verify medical necessity pairings. Whatever the pairing, every diagnosis code must be supported by documentation in the record for the date of service billed.

Where to verify the code

To verify S82.026P or explore adjacent codes, these authoritative sources provide official tabular list access and coding guidance aligned with current CMS requirements.

• The CDC/NCHS ICD-10-CM web tool provides the official U.S. tabular list with searchable code lookup by year.
• The CMS ICD-10 codes page publishes annual update files, including code additions, deletions, and revisions effective each October 1.
• The WHO ICD-10 browser gives access to the international classification hierarchy for context. U.S. coders should still use ICD-10-CM for HIPAA-covered transactions.

Fracture episode coding only holds up if the notes behind it do. The habits that produce safer clinical notes and HIPAA-compliant records apply in orthopedic and physical therapy settings too.

How Pabau supports accurate fracture coding

Fracture coding errors usually start in the clinical note. A clinician records “healed patella fracture” and moves on to the exercise plan.

The coder is then left with nothing that supports P rather than D, so the claim goes out understated. It can also come back with one of the standard denial codes attached.

Practice management software like Pabau lets you attach documentation prompts to the codes your practice bills most often. When a clinician opens a fracture follow-up note, the template asks for encounter type, wound status, fracture pattern, and healing outcome. Radiographic findings are captured in the same record as the diagnosis.

Pabau’s claims management then carries that structured note through to submission, so the 7th character you send is the one the record supports. Your team spends less time reworking denials and more time with patients.

Electronic claims leave through our Claim.MD integration, the clearinghouse that scrubs each claim before the payer sees it. Claims management, medical records, and reporting are included in every Pabau subscription.

Reduce fracture coding errors before they reach the payer

Pabau lets orthopedic and physical therapy teams configure code-level documentation prompts and track 7th character compliance. Encounter-type mismatches surface when the note is completed, well before denial review.

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Conclusion

S82.026P is decided in the clinical note, not at the billing desk. If the imaging report says the patella fracture healed and stops there, the record supports routine healing and nothing more. Ask for the alignment finding while the clinician is still in the chart.

That one habit is worth more than any extension table. Once wound status, encounter type, and healing outcome are recorded at every follow-up, the 7th character stops being the coder’s guess.

Pabau’s claims management helps orthopedic and physical therapy practices build those prompts into the encounter workflow. Book a demo to see how it keeps fracture claims tied to the notes that support them.

Continue your research

Coding a femur malunion at a follow-up visit? S72.414P applies the same subsequent-encounter malunion rules at the lower end of the femur.

Need the open-fracture version in the femur? S72.442C covers a displaced lower femur fracture at an initial encounter for a severe open injury.

Documenting soft-tissue damage alongside the fracture? S86.921A covers a muscle laceration in the lower leg at an initial encounter.

Waiting on approval for corrective surgery? Prior authorization software compares the tools that track approvals before a procedure is scheduled.

Frequently asked questions