ICD-10 code S82.233J: Open tibia shaft fracture, delayed healing

Key takeaways

ICD-10 code S82.233J covers a displaced oblique fracture of the tibial shaft at a follow-up visit, open Gustilo type III, with delayed healing.

The sixth character 3 means unspecified tibia. The record did not name a side, so this is not the left-tibia code.

Seventh character J carries three facts: A subsequent encounter, an open type IIIA, IIIB or IIIC fracture, and delayed healing.

J is not nonunion. Open type III nonunion takes N, so the left-tibia nonunion code is S82.232N.

Practice management software like Pabau builds the CMS-1500 claim from the encounter record, so the diagnosis you coded is the one that ships.

ICD-10 code S82.233J reports an open fracture of the tibial shaft that is healing too slowly. The code is billable, and two of its characters do almost all of the work.

The sixth character 3 says the chart never named a side. The seventh character J says three more things at once. The visit is a follow-up, the original injury was open Gustilo type IIIA, IIIB or IIIC, and the provider has documented delayed healing.

Two mistakes follow this code around. Coders reach for J when the note says nonunion, which takes N. They also read the third 3 as left, which is S82.232. Both are settled below.

What ICD-10 code S82.233J means, and when you can bill it

S82.233J is a billable, specific ICD-10-CM code. You report it at a follow-up visit for a displaced oblique fracture of the tibial shaft. The original injury has to be documented as an open fracture of Gustilo type IIIA, IIIB or IIIC. The provider must also state that healing is behind schedule.

Per the Centers for Medicare and Medicaid Services, ICD-10-CM is updated every October. This code is valid in every HIPAA-covered transaction from October 1, 2025. Its wording has not changed since FY2016.

One detail decides whether the claim clears the first edit. S82.233 on its own is not billable, so a truncated six-character string fails at the clearinghouse. Only the full seven-character code reaches a payer.

Where S82.233J sits in the ICD-10-CM hierarchy

Five levels separate the category from the billable code. Each one narrows the description, and each one has to be supported somewhere in the chart.

Segment, pattern, displacement and laterality are fixed by the original injury and by what the chart says about it. Only the seventh character changes as the patient moves through treatment.

The sixth character is unspecified laterality, not left

This is the character that gets misread most often on S82.233J. The third 3 does not mean left. It means the tibia was not identified as left or right anywhere in the documentation.

Subcategory S82.23 packs two variables into that one position. Displacement runs first, then laterality, in the order right, left, unspecified.

The sixth character repeats one order twice. Nondisplaced runs right, left, unspecified as 4, 5 and 6. The displaced rows above them run the same way as 1, 2 and 3.

That makes S82.233J a code you should rarely need. The tibia is a paired bone, and the side is recorded in the operative note, the imaging report and the consent form. An unspecified code on a follow-up claim usually means the side was never carried forward into today’s note.

Payers read it the same way. Unspecified laterality on a limb injury invites a medical necessity review, because the plan cannot match the claim to the surgery it already paid for. Query the provider and move to S82.231J or S82.232J when the record supports a side.

Seventh character J carries three facts at once

J tells the payer that this is a subsequent encounter, that the fracture was open at Gustilo type III, and that healing has slowed. Change any one of those three facts and the character changes with it.

The grid below shows why. Fracture type runs across the top, healing status runs down the side, and J sits in a single cell where the two meet.

N is the row directly below J. It describes the same open type III fracture that has stopped healing altogether. K is a step further away, because it changes the fracture type to closed as well as the healing status.

The full seventh character set for S82.233

Every valid extension for S82.233 is listed below. Each one produces a distinct billable code, and the letters I, L and O are skipped so nobody reads them as 1 or 0.

Descriptions above follow the FY2026 tabular list. You can confirm any of them in the CDC and NCHS ICD-10-CM lookup tool before you submit.

Gustilo type III is what makes this an open fracture code

The open fracture designations in the seventh character come from the Gustilo-Anderson classification. The surgeon assigns it at the index procedure, and it then follows the patient through every later visit.

• Type I: A clean wound under 1 cm, with little soft tissue damage. Takes characters B, E, H, M or Q.
• Type II: A wound larger than 1 cm without extensive soft tissue loss or flaps. Also takes B, E, H, M or Q.
• Type IIIA: Extensive soft tissue damage, but the bone still has adequate soft tissue coverage. High-energy trauma counts here whatever the wound size.
• Type IIIB: Extensive soft tissue loss with periosteal stripping and exposed bone. Coverage usually needs a flap.
• Type IIIC: An open fracture with an arterial injury that needs repair.

All three type III grades share one set of characters, so S82.233J covers IIIA, IIIB and IIIC alike. The distinction between them drives the surgical work, not the diagnosis code.

There is a default worth knowing. The ICD-10-CM Official Guidelines say that when the Gustilo type is not documented, you assign the characters for type I or II. At a delayed-healing follow-up, that means H rather than J.

Delayed healing is the provider’s call, not the coder’s

ICD-10-CM never defines delayed healing in weeks or months. It is a clinical judgment the treating provider writes into the note. A coder cannot read an X-ray report and decide that union is behind schedule.

The four healing states below map to different characters, and the fracture type decides which column you read.

Reading the table left to right separates the two findings coders swap. Delayed healing and nonunion describe different clinical states. Each one then splits again by fracture type.

The distinction has money attached. Payers treat continued delayed healing as active management, and nonunion as a trigger for surgical intervention. Tracking which one your denials cluster around starts with the denial reason codes on the remittance.

When S82.233J replaces S82.233C, and when it does not

Encounter type follows the nature of the care, not the visit number. A patient can be coded as an initial encounter several times while active treatment continues. The switch happens when treatment ends and the patient moves into follow-up.

For an open type III oblique tibial shaft fracture, the sequence usually runs like this.

Encounter type drives a steady share of rework on injury claims. Confirm that active treatment has ended before you reach for a subsequent character.

Sibling codes you will reach for next

Most coding on this family is a small edit to one variable. The table below holds the neighbors worth bookmarking, with the single difference that separates each from S82.233J.

Two rows deserve a second look. S82.232N is the code many notes describe, because it names a left tibia that has stopped healing. S82.233N is its unspecified twin, and neither one uses the letter J.

Index entries that route documentation to S82.233J

Surgeons rarely write in code descriptions. These are the phrasings that should send you to this code when you search the alphabetic index by clinical language.

• Open displaced oblique fracture of the tibial shaft, side not stated, delayed union
• Compound oblique tibia shaft fracture, Gustilo IIIA, slow to unite
• Tibial diaphysis fracture, type IIIB open injury, healing behind schedule
• Grade III open oblique tibial shaft fracture, follow-up, delayed consolidation
• Delayed union of an open oblique tibial shaft fracture, laterality not documented

The index path is Fracture, traumatic → tibia → shaft → oblique (displaced). Laterality comes next, and the seventh character comes last.

How an S82.233J claim moves, and where it stalls

This code does not change how a claim travels. It changes where the claim gets stuck, and there are only two places that happens.

1. The visit. The surgeon reviews the imaging and the wound, then writes the healing status into the note. Without that line, the seventh character is a guess.
2. Charge capture. The diagnosis pairs with the work performed. A follow-up assessment often sits on an established patient visit such as CPT code 99213, with an imaging code added when films were taken.
3. Clearinghouse edits. Format checks run first. A truncated S82.233 rejects here, which is the cheapest place in the chain to catch it.
4. Payer adjudication. The plan reads J as a clinical statement about an open type III injury. Unspecified laterality is the flag that most often stops it here.
5. Remittance. A denial on this line usually traces back to the note rather than the code choice.

That gives you a short routine to run before the claim leaves. Six checks, and five of them live in the chart:

• The note describes the fracture as displaced and oblique.
• The note either names a side, or genuinely does not record one.
• The original injury is documented as open, with a Gustilo type of IIIA, IIIB or IIIC.
• The provider, not the coder, has called the healing delayed at this visit.
• The visit is follow-up care, not active treatment of a fresh injury.
• The code on the claim line carries all seven characters.

Only the last check is a keystroke. The other five live in the chart, which is where review time on this code pays off.

Documentation that keeps an S82.233J claim clean

The record has to carry five facts at once. When it does, the claim holds up under review without an appeal.

What the record must show

• Fracture pattern: Oblique, in the provider’s own assessment rather than only in a radiology impression.
• Displacement: Displaced, stated explicitly. ICD-10-CM defaults to displaced when the note is silent, but a clear statement is always safer.
• Laterality: The side, if it appears anywhere. S82.233J is only correct when no note in the episode names left or right.
• Open status and Gustilo type: The index operative note names the fracture as open and grades it IIIA, IIIB or IIIC.
• Encounter and healing status: This visit is follow-up care, and the provider states that union is behind schedule.

Mistakes that trigger a denial

• J used when the note says nonunion. For an open type III fracture that is N. Read the healing statement before you pick the letter.
• J used as if the sixth character meant left. Left is S82.232, and right is S82.231.
• Unspecified laterality when the chart names a side. The operative note usually settles it, so query before you submit.
• J used when the Gustilo type was never documented. The guidelines default to type I or II, so the correct character is H.
• A missing seventh character. S82.233 on its own is invalid and rejects before a payer ever sees it.
• Switching to a closed character once the wound heals. The open designation belongs to the original injury and does not change later.

How Pabau keeps seventh-character fracture claims clean

Most of the work above happens in two systems that rarely talk to each other. The healing statement lives in the clinical note. The claim gets rebuilt somewhere else, often from a superbill written after the visit.

Practice management software like Pabau keeps both on one record. Its claims management software pre-fills the CMS-1500 from the encounter, so the diagnosis you coded is the diagnosis that ships. An ICD-10-CM library lets a coder check the seventh character set without leaving the chart.

Required-field checks run before the claim unlocks, which stops incomplete submissions at the desk. On the US pipeline, Claim.MD handles submission, real-time eligibility checks and remittance posting. A denial lands back on the same record as the note behind it, so your coder reads both together.

Keep open fracture follow-up claims moving

Pabau pre-fills the CMS-1500 from the encounter record, checks eligibility before the visit, and posts remittance advice back to the same chart. Your coders read the note and the denial reason side by side.

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Conclusion

S82.233J is settled by two lines someone else wrote. One is the Gustilo type from the index surgery. The other is the healing status at today’s visit. Find both, or ask for them.

Then check the side. The third 3 in this code means the tibia was never identified as left or right. That is a documentation result rather than a clinical one. When the chart does name a side, S82.231J or S82.232J is the honest code.

Trouble on this code starts in the note far more often than in the lookup. A claim that says delayed healing while the chart says nonunion tells the payer a different story. The note decides which one you are paid for.

Book a demo to see how Pabau ties the coded encounter to the claim that leaves your practice.

Continue your research

Coding the same seventh character on a different bone? ICD-10 code S72.352J works through delayed healing on an open femoral shaft fracture.

Need the nonunion side of this logic? ICD-10 code S82.091N shows what the record must prove when union has stopped.

Reading a denial on a fracture line? Denial codes in medical billing maps the reason codes you will meet most often.

Not sure what makes a claim clean before it leaves? Clean claim sets out the checks that stop a rejection at the clearinghouse.

New to electronic claim submission? Claim.MD clearinghouse explains how 837P submission, remittance advice and eligibility checks fit together.

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