ICD-10 Code S82.192A: Other fracture of upper end of left tibia

Key takeaways

S82.192A is a billable ICD-10-CM code for other fracture of upper end of left tibia, initial encounter for closed fracture.

It became effective on October 1, 2025 and is valid for the FY2026 edition of ICD-10-CM.

The 7th character A means an initial encounter for a closed fracture, while later stages take D, G, K, P, or S.

‘Other fracture’ separates this code from the displaced and nondisplaced subtypes, so the note must confirm laterality, fracture type, and encounter stage.

Pabau’s claims management supports accurate ICD-10 entry and clean claim submission for orthopedic and physical therapy practices.

ICD-10 Code S82.192A is a billable diagnosis code for an other fracture of the upper end of the left tibia. It applies at an initial encounter for a closed fracture. “Other fracture” separates it from the displaced and nondisplaced subtypes in the same subcategory. The 7th character A confirms the patient is still under active treatment for a closed injury.

Coders reach for S82.192A most often after an emergency visit or a first orthopedic evaluation. Two decisions follow from there. The first is which 7th character applies at each later visit. The second is which sibling code covers the other side or an open wound.

ICD-10 Code S82.192A: Definition and billable status

ICD-10 Code S82.192A is a billable, specific ICD-10-CM diagnosis code. Its full official description is: Other fracture of upper end of left tibia, initial encounter for closed fracture.

According to the CDC/NCHS ICD-10-CM web tool, the code became effective on October 1, 2025 and is valid for the fiscal year 2026 edition. It is accepted for HIPAA-covered electronic transactions and stands on its own as a diagnosis code for reimbursement.

“Billable/specific” means S82.192A carries enough clinical detail to go on a claim without a more granular child code. It sits at the terminal level of the ICD-10-CM hierarchy for this fracture presentation.

What the 7th character means for S82.192A

The 7th character is a required part of an ICD-10-CM fracture code. It changes the code’s clinical meaning rather than qualifying it. For the S82.192 family, that character tells payers which phase of care the visit belongs to. The patient is presenting for the first time, returning for ongoing care, or being seen for a complication of healing.

Character A designates an initial encounter for a closed fracture. According to CMS ICD-10 coding guidance, “initial encounter” applies while the patient is receiving active treatment for the fracture.

That covers the emergency department visit, the first orthopedic evaluation, and the application of a cast or splint. The label reaches every visit where active treatment continues, including the second and the third.

Switching from A to D too early is one of the most common 7th character errors in orthopedic billing. If a provider continues active casting or manipulation, the encounter stays initial even on the third or fourth visit.

Only when treatment turns into routine monitoring does the encounter become subsequent. Payers report the resulting rejection with a specific remittance code, and the denial codes reference lists the ones fracture claims hit most.

S82.192A code hierarchy and parent codes

ICD-10 Code S82.192A sits inside a structured hierarchy. Each character position carries one piece of the specificity. Reading the code from left to right names the site, the subtype, the side, and the stage of care.

The path from category to terminal code runs like this:

• 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
• S82.1: Fracture of upper end of tibia
• S82.19: Other fracture of upper end of tibia
• S82.192: Other fracture of upper end of left tibia (without 7th character)
• S82.192A: Other fracture of upper end of left tibia, initial encounter for closed fracture (terminal, billable)

S82.192 is not itself billable. The 7th character completes the code, and a claim carrying S82.192 without it will be rejected. Parent codes define the anatomical site and the injury type, while the final characters add the laterality and the encounter stage.

Related ICD-10 codes for proximal tibia fractures

S82.192A belongs to a code family covering every presentation of an upper-end tibia fracture. Laterality and fracture subtype decide which sibling code applies, and laterality is among the most audited elements in orthopedic billing.

S82.199A belongs on a claim only where the operative report or the clinical note genuinely does not state left or right.

Payers audit laterality routinely and may downcode or deny a claim that reports “unspecified” when the side is documented. Always default to the laterally specific code. For an open wound at the initial visit on the right side, the sibling code is S82.191B.

Coding guidelines and documentation requirements

Using ICD-10 Code S82.192A correctly requires documentation that supports all three elements built into it: the fracture location, the laterality, and the encounter type. Leaving any one of them out of the clinical record creates an audit vulnerability even when the code itself is correct.

The ICD-10-CM Official Guidelines for Coding and Reporting, maintained by the National Center for Health Statistics, are the authoritative source for fracture coding conventions. Key requirements for S82.192A include:

• Laterality confirmation: The clinical note, imaging report, or operative record must state “left tibia” explicitly. A radiology report reading “left proximal tibia fracture” is enough. A report reading “tibial fracture” without a side is not.
• Open vs. closed designation: S82.192A covers closed fractures only. If the skin is broken or the wound communicates with the fracture site, the open fracture codes S82.192B or S82.192C apply. The physical exam or the operative findings must document skin integrity.
• Fracture subtype: “Other fracture” covers patterns that the subtype codes for that anatomy do not classify as displaced or nondisplaced. The clinical record describes the fracture pattern, and the coder maps it to the matching subtype heading in the tabular list.
• Encounter type: The provider’s note should describe the nature of the visit. Active treatment, monitoring of healing, and management of a complication each drive a different 7th character.
• External cause code: ICD-10-CM guidelines recommend reporting an external cause code alongside S82.192A. Draw it from the W, V, or Y categories to indicate how the injury occurred.

A documentation checklist built into the intake or encounter workflow keeps incomplete records out of the coding queue. The FY2026 ICD-10-CM official guidelines from NCHS are the baseline an internal coding policy should match.

When to use S82.192A vs other S82.192 encounter codes

Use S82.192A for as long as active treatment continues, then move to a subsequent-encounter character once care becomes monitoring. That transition point is where the coding usually breaks down, because a practice without a written policy keeps billing A after the cast comes off.

Physical therapy visits are a common billing pitfall. If the PT encounter treats a closed left proximal tibia fracture that is healing on schedule, the diagnosis code is S82.192D rather than S82.192A. An encounter-type prompt in the scheduling or documentation workflow catches that at the point of care.

Billing S82.192A: Claim submission and reimbursement

ICD-10 Code S82.192A goes on the claim as a diagnosis code, paired with the CPT procedure code for the service rendered. The CPT code drives the payment, and S82.192A establishes medical necessity. Payers cross-reference the two to confirm the procedure suits the diagnosis.

Practices submitting fracture claims through practice management software like Pabau can route them to Claim.MD, our integrated US clearinghouse partner.

Claim.MD validates code combinations before submission and flags a mismatched CPT and ICD-10 pairing before it reaches the payer. Catching an encounter-character error at that stage removes a round of rework on a musculoskeletal claim.

CPT codes commonly paired with this diagnosis

S82.192A is a diagnosis code. It describes the patient’s condition, and the CPT code describes the treatment rendered. The table below lists the CPT codes most often billed with S82.192A for upper-end tibia fractures.

Verify each pairing against payer policy and AAPC’s ICD-10-CM code lookup, since coverage rules vary by payer and region.

When ORIF is performed under CPT 27536, the diagnosis at surgery is still S82.192A if this is the initial surgical encounter. The 7th character does not shift with the invasiveness of the procedure. It reflects whether the patient remains in the active treatment phase of the injury episode.

How Pabau supports accurate ICD-10 coding for fracture diagnoses

Coding accuracy for an orthopedic diagnosis like S82.192A depends on how complete the clinical record is when the coder opens it. When the note leaves out the laterality or the encounter stage, the coder has two poor options. Querying the provider adds days to the billing cycle, and falling back on a less specific code invites payer scrutiny.

Pabau keeps the coded diagnosis attached to the clinical record, so the claim inherits it without manual re-entry. Its cleaner claims management ties the note, the code, and the submission together in one pass.

For orthopedic and physical therapy practices, Pabau connects to Claim.MD for electronic submission, real-time eligibility verification, and ERA posting. Built-in CPT and ICD-10 catalogs validate code combinations before they reach the payer, so a fracture billing error surfaces before it becomes a denial.

Reduce coding errors and claim denials on orthopedic diagnoses

Pabau’s integrated claims management connects directly to Claim.MD for pre-submission validation, real-time eligibility checks, and ERA posting. See how practices using Pabau cut fracture claim rework time significantly.

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Conclusion

ICD-10 Code S82.192A covers one specific presentation. It is a closed left proximal tibia fracture classified as “other”, seen while active treatment is still under way. Get the laterality, the subtype, and the encounter stage into the note, and the code follows without a query back to the provider.

The trade-off worth remembering is that specificity is cheap at the point of documentation and expensive at the point of appeal. Book a demo to see how Pabau moves a fracture diagnosis from the clinical note to a paid claim.

Continue your research

Need to understand how clearinghouse validation reduces fracture claim denials? Denial management in healthcare covers the most common denial triggers and how to build an effective appeal workflow.

Looking for a structured workflow for billing physical therapy visits after a fracture? Revenue cycle management fundamentals explains how each phase from documentation through payment posting connects.

Want the pre-submission checks that stop a fracture claim from bouncing? Clean claim sets out what a payer needs on the first pass and which errors force a resubmission.

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