ICD code S82.242H – Displaced spiral left tibial shaft fracture

Key takeaways

S82.242H is a billable ICD-10-CM code for a displaced spiral fracture of the left tibial shaft with documented delayed healing. It applies at follow-up visits for an open fracture, Gustilo type I or II.

The 7th character H carries three facts: subsequent encounter, open fracture type I or II, and delayed healing. A closed fracture with delayed healing takes G, and a type III open fracture takes J.

Documentation must state that healing is slower than expected, backed by imaging. That statement is what justifies H over E, the routine healing character.

Pabau’s claims management software, integrated with the Claim.MD clearinghouse, helps orthopedic practices submit S82.242H claims accurately and track delayed-healing documentation requirements.

ICD-10 Code S82.242H: Definition and code details

ICD-10 Code S82.242H designates a displaced spiral fracture of the left tibial shaft with delayed healing. It applies at a subsequent encounter for an open fracture, Gustilo type I or II.

It sits in category S82, which covers fractures of the lower leg, including the ankle. The code is valid under ICD-10-CM for the current fiscal year.

Clinical description: Displaced spiral tibial shaft fracture with delayed healing

A displaced spiral fracture of the tibial shaft results from a rotational or torsional force on the lower leg. It produces an oblique fracture line that spirals around the bone’s long axis. The shaft is the diaphysis, the straight middle portion of the tibia between the proximal and distal metaphyses.

“Displaced” means the fracture fragments have shifted out of anatomic alignment. That distinction matters for code selection, because S82.244, S82.245, and S82.246 cover nondisplaced spiral tibial shaft fractures. Using S82.242H on a nondisplaced fracture is a coding error that may pass initial submission but create audit exposure.

Delayed healing, the healing status encoded by the 7th character H, means the fracture is not progressing through the expected healing trajectory.

The ICD-10-CM Official Guidelines set no timeframe for delayed healing. It is a clinician determination documented in the medical record, usually supported by serial imaging that shows too little callus for the time since injury.

For adult tibial shaft fractures, clinical literature often links delayed healing to a lack of bridging callus at 12 to 16 weeks. Treating physicians may still identify it earlier or later, based on nutrition, comorbidities, smoking status, and fixation stability.

Coders should reflect the physician’s documented assessment rather than apply an arbitrary cutoff. A follow-up note template that asks the physician to state healing status at each visit puts that assessment on the page before coding starts.

Open fracture type I or II: The Gustilo grade behind H

An open fracture is one where the broken bone has pierced the skin, or a wound communicates with the fracture site. ICD-10-CM splits open fractures by the Gustilo-Anderson classification, and the 7th character records the grade the physician documented.

• Type I: a clean wound under 1 cm, with minimal soft tissue damage.
• Type II: a wound over 1 cm, without extensive soft tissue damage, flaps, or avulsion.
• Types IIIA, IIIB, and IIIC: extensive soft tissue damage, periosteal stripping with exposed bone, or an arterial injury that needs repair.

Types I and II share one set of 7th characters, which is why H covers both. Types IIIA to IIIC share another, so a type III fracture with delayed healing takes J instead.

Two ICD-10-CM defaults shape the choice. A fracture not documented as open or closed is coded as closed, which makes G the right character. An open fracture documented without a Gustilo grade defaults to type I or II, which keeps H in play.

The open or closed status is fixed at the injury. A type II wound that has fully closed by the twelve-week visit is still an open fracture for coding. The follow-up keeps H and never switches to G.

Understanding the 7th character H: Open fracture type I or II with delayed healing

The 7th character H carries three facts at once. This is a subsequent encounter, after the initial treatment phase. The original fracture was open, graded Gustilo type I or II. The treating clinician has documented delayed healing. The record must support each of the three to justify H over its neighbors.

Per the CMS ICD-10-CM coding guidelines, a subsequent encounter covers visits after the patient has received active treatment for the condition.

The most common error is assigning E, routine healing for a type I or II open fracture, when the note describes concerns about healing pace. S82.242E fits only when the physician records healing on schedule.

The reverse error is assigning H when the note has no explicit physician statement about delayed healing. A third is reaching for G, the closed-fracture character, because the skin has healed by the follow-up visit. In each case the physician’s documentation decides the character, and coder inference cannot stand in for it.

The grid below shows how two facts, the wound status at injury and the healing status at this visit, settle every subsequent-encounter character for S82.242.

7th character options for S82.242: Full reference table

S82.242H in the broader S82.242 code family

S82.242H sits within the displaced spiral tibial shaft subgroup (S82.241 through S82.249). Laterality, open or closed status, Gustilo grade, and healing status all split the family, and each split is a common miscoding point.

Inclusions, exclusions, and crosswalk notes for S82.242H

S82.242H includes tibial shaft fractures that meet every element of the descriptor. The fracture is displaced, spiral, in the shaft, and on the left side. It was open, Gustilo type I or II, and this is a subsequent encounter with documented delayed healing.

Several fracture types are excluded from this code. Per ICD-10-CM tabular guidance, the S82 category excludes periprosthetic fractures of the knee (M97.-) and pathological fractures (M84.5-). It also excludes fractures due to osteoporosis (M80.-) and traumatic amputation of the lower leg (S88.-).

Tibial fractures described as “stress fractures” fall under M84.36-, not S82. Applying S82.242H to a stress fracture is an excludes1 violation.

Documentation requirements to support S82.242H

Documentation that supports ICD-10 Code S82.242H must address five elements. Missing any one of them creates either a coding error or a claim denial trigger.

1. Confirmation of displacement: The treating physician’s note or radiology report should describe the fracture as displaced, or describe fragment shift in quantitative terms. ICD-10-CM codes a fracture with no displacement status as displaced by default. A nondisplaced finding anywhere in the record moves the code to S82.245-.
2. Spiral fracture pattern on imaging: The radiology report should explicitly identify a spiral or torsional fracture morphology. “Oblique-spiral,” “spiral configuration,” and “helical fracture” are acceptable equivalents. “Transverse fracture” or “comminuted fracture” would point to different codes within S82.
3. Open fracture, Gustilo type I or II: The initial encounter record must show the fracture was open. The physician’s Gustilo grade should be type I or II, and an open fracture with no grade defaults to type I or II. A documented type IIIA, IIIB, or IIIC grade moves the code to S82.242J.
4. Left laterality: The chart must specify left tibia. If the operative report or imaging report uses “ipsilateral” or “contralateral” without an absolute reference, coders should query the physician before selecting laterality.
5. Physician attestation of delayed healing: The note must say the fracture is “healing poorly,” “showing inadequate callus,” “not progressing as expected,” or something similar. Serial X-ray comparisons described in a progress note provide strong support. The phrase “delayed healing” need not appear verbatim, but the clinical meaning must be unmistakable. Coders should not infer delayed healing from a long time since injury alone. The physician must document the clinical assessment.

For practices wanting structured documentation that prompts these elements consistently, a fracture follow-up note template can reduce the time spent chasing addenda. See Pabau’s guidance on clean claim submission for orthopedic billing contexts.

Payer requirements and prior authorization considerations

Most payers, including Medicare, do not require prior authorization for routine follow-up of a tibial shaft fracture. Procedures often billed alongside delayed healing, such as bone stimulation, repeat fixation, or bone grafting, frequently do. ICD-10 Code S82.242H is the diagnosis that supports medical necessity for those requests.

Medicare covers noninvasive electrical bone stimulation for long bones (HCPCS E0747) under the DME MAC Local Coverage Determination for osteogenesis stimulators.

That policy is written around nonunion: two sets of radiographs at least 90 days apart showing no clinically significant healing. A delayed-healing diagnosis alone may not meet it, so check the current LCD before billing a stimulator with S82.242H.

Commercial payers commonly require the following before accepting S82.242H as the primary diagnosis on intervention-related claims:

• Attending physician note explicitly documenting delayed healing at the current encounter
• Comparative imaging reports (at minimum two X-ray series showing inadequate progression)
• Documentation of conservative treatment tried before any intervention is proposed
• Initial encounter record confirming the fracture was open and graded Gustilo type I or II, which rules out G (closed) and J (type III)

Using Pabau’s claims management software, practices can attach supporting documentation directly to claims and track prior authorization status against the encounter. That cuts the back-and-forth that delayed-healing cases usually generate.

Common claim denials for S82.242H and how to avoid them

Most S82.242H denials trace back to a mismatched 7th character or a note that never states delayed healing. The table below maps each common denial pattern to its root cause and fix.

Proactive denial management workflows resolve these cases faster when they route S82.242H denials to a fracture-coding specialist instead of a general queue. Pabau’s Claim.MD clearinghouse integration surfaces payer acceptance signals and ERA denial reason codes, known as CARC codes, as they come back.

Your team can then spot the specific 7th character or documentation denial before the 60-day appeal window closes. For the reason codes that most often appear on S82.242H remittances, see this guide to medical billing denial codes.

CPT codes commonly paired with S82.242H

The CPT codes billed alongside ICD-10 Code S82.242H depend on what intervention the surgeon or treating physician performs at the encounter. Delayed healing often triggers a review or secondary intervention that changes the procedure code from a simple follow-up.

When the follow-up encounter includes only evaluation and management without a procedure, the E/M code (99213 or 99214) carries S82.242H as the primary diagnosis.

Practices can review electronic remittance advice patterns on these paired claims to see whether payers keep downgrading the E/M level. Repeated downgrades usually mean the note under-documents medical decision-making, and recoding the diagnosis won’t fix that.

How Pabau keeps S82.242H claims tied to the fracture record

Coding S82.242H correctly depends on facts recorded weeks apart. The Gustilo grade sits in the initial encounter note, the delayed-healing statement in a later progress note, and the comparison imaging in the radiology report. When those records live in separate systems, coders rebuild the story by hand at every follow-up.

Pabau’s practice management platform keeps the patient’s notes, forms, and claims in one record. Custom note templates can prompt the physician to record the open fracture grade and healing status at each visit. Pabau’s claims management software then lets the biller attach those notes and imaging reports to the claim before it goes out.

Claims route through the Claim.MD clearinghouse integration, so payer rejections and ERA denial codes come back into the same record. A wrong 7th character gets caught and corrected while the appeal window is still open.

Submit fracture follow-up claims that hold up

Pabau keeps clinical notes, imaging reports, and claims in one patient record, with Claim.MD clearinghouse integration built in. Your team can check the 7th character against the note before the claim leaves the practice.

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Conclusion

S82.242H holds up on audit when the record proves five facts. The fracture is displaced, spiral, and on the left side. It was open and graded type I or II, and the physician states that healing is delayed. Lose one and the right code is a different letter. That means G for a closed fracture, J for type III, E for routine healing, or M once nonunion is confirmed.

The habit worth building is to open the initial encounter note before choosing any subsequent character. The Gustilo grade is set on the day of injury, and every follow-up code inherits it, even after the wound has closed.

Book a demo to see how Pabau keeps fracture notes, imaging reports, and claims in one record for orthopedic practices.

Continue your research

Need to understand how clearinghouse rejection codes map to your denials? Pabau’s Claim.MD clearinghouse guide explains how thousands of US payers process claims and how ERA denial codes surface in your remittance workflow.

Want a reference for common denial reason codes on fracture claims? Revenue cycle management for medical practices covers the end-to-end billing process including denial patterns and resolution strategies.

Looking to verify ICD-10-CM code accuracy before submission? Medical billing fundamentals outlines the documentation requirements that support accurate diagnosis code selection across specialties.

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