ICD code S82.255S – Nondisplaced comminuted left tibial shaft fracture sequela

Key takeaways

S82.255S applies only to a nondisplaced comminuted fracture of the left tibial shaft, after healing is complete and a residual condition remains.

The seventh character S marks a sequela under ICD-10-CM Guidelines I.C.19.a, and it never replaces D for visits during active healing.

On a sequela claim, the code for the residual condition goes first and S82.255S goes second, per Guidelines I.B.10.

A fracture not documented as nondisplaced is coded as displaced, so the record must state nondisplaced to support S82.255S over S82.252S.

Pabau, the practice management platform we build, checks each claim for missing or invalid details before it reaches the Claim.MD clearinghouse.

ICD-10 code S82.255S at a glance

ICD-10 code S82.255S is the billable ICD-10-CM code for a nondisplaced comminuted fracture of the shaft of the left tibia, sequela. It sits in subcategory S82.25, which covers comminuted fractures of the tibial shaft. The table below captures the reference fields coders need before building a claim.

Verify billable status against the CDC/NCHS ICD-10-CM web tool each fiscal year, as code descriptors and billable flags update annually on October 1.

What S82.255S covers: Official descriptor and anatomical scope

A comminuted fracture is one in which the bone breaks into three or more fragments rather than two clean pieces. In the S82.2 block, “shaft” refers to the diaphysis of the tibia, the long mid-section of the bone between the proximal and distal metaphyses. Each character of S82.255S carries one part of the descriptor:

• S82 (category): fracture of lower leg, including ankle
• 2 (fourth character): fracture of the shaft of the tibia
• 5 (fifth character): comminuted fracture pattern, so S82.25 is the comminuted tibial shaft subcategory
• 5 (sixth character): nondisplaced, left tibia (the right-side counterpart is S82.254S, and the unspecified-side code is S82.256S)
• S (seventh character): sequela

The sixth character carries displacement and laterality together. Values 1, 2 and 3 mean displaced right, left and unspecified, while 4, 5 and 6 mean nondisplaced right, left and unspecified. The grid below maps all six sequela codes in the subcategory.

Displacement must be documented, too. ICD-10-CM instructs coders to report a fracture not indicated as displaced or nondisplaced as displaced. A radiology report that only says “comminuted fracture of the left tibial shaft” therefore leads to S82.252S, not S82.255S.

Residual conditions reported with S82.255S include pain after union, angular deformity from malunion, acquired leg-length discrepancy, stiffness, and chronic osteomyelitis after an open fracture. Each must be documented as a direct consequence of the original fracture, not as a new injury or an unrelated condition.

Understanding the seventh character ‘S’ for sequela

The seventh character S designates sequela under ICD-10-CM Official Guidelines Section I.C.19.a. It means the encounter is for a late effect of the injury after healing is complete.

Tibial shaft fracture codes in S82.2 accept more seventh characters than most injury codes. The main options are A, D and S. Further characters cover open fractures and subsequent visits for delayed healing, nonunion or malunion.

Two conditions must both be present before S is appropriate. The fracture has healed, confirmed clinically or radiographically, and the provider links a specific residual condition to the original fracture in the note. Missing either one means the claim lacks the clinical basis to support S82.255S.

Sequela vs subsequent encounter: Choosing D or S for fracture aftercare

D marks a subsequent encounter during routine healing, and S marks a sequela after healing. They are the two seventh characters most often confused in fracture coding. Using one where the other belongs is a common denial trigger on S82.255S claims.

Physical therapy visits during active healing take the D character. Once the provider documents union and a residual impairment drives the PT, the coder lists the residual condition first and S82.255S second. This switch causes frequent confusion on PT claims, and denial management workflows often flag S82 claims for review because of it.

Codes easily confused with S82.255S

Subcategory S82.25 holds six sequela codes, split by laterality and displacement. Errors on S82.255S usually come from one of three choices: the side, the displacement status, or the fracture pattern.

For a full crosswalk of adjacent codes, use the AAPC Codify ICD-10-CM lookup or the ICD List browser. Both display the complete S82 code tree with parent-child relationships and excludes notes.

Nonunion and malunion: When S82.255S applies

Nonunion means the fracture fails to heal, and malunion means it heals in an abnormal position. Both are serious outcomes of a comminuted tibial shaft fracture. Both have their own seventh characters, so S applies only once the fracture phase is over.

Nonunion tibia fracture ICD-10 coding

Nonunion during fracture care takes a subsequent-encounter character rather than the sequela one. S82.255K covers a subsequent encounter for a closed fracture with nonunion, and M and N cover open fractures.

S82.255S applies when the nonunion has been treated, the fracture phase has ended, and a residual condition drives the visit. Check current AHA Coding Clinic advice for borderline cases, as payers scrutinize these claims closely.

Malunion as a sequela

Malunion also has subsequent-encounter characters: P for a closed fracture, and Q or R for open fractures. Use S82.255P while the malunion is still being managed as part of fracture care. Once the fracture has healed in malalignment and the visit addresses a late effect, code that condition first and S82.255S second.

Document the relationship explicitly: “acquired leg-length discrepancy secondary to healed nondisplaced comminuted left tibia fracture with malunion.” Without that causal statement in the note, the residual condition code lacks clinical support.

Coding S82.255S correctly: Step-by-step documentation requirements

Assigning S82.255S rests on five documented facts and one sequencing rule. Work through these seven steps in order.

1. Confirm fracture healing is complete. The provider note must state that the fracture has healed, supported by imaging (x-ray, CT) or clinical examination. “Healing well” is not sufficient; the documentation must confirm union.
2. Identify the residual condition. The note must name a specific sequela, such as pain, deformity, stiffness, or malunion. “Post-fracture status” alone does not support S.
3. Verify laterality is left. Confirm the injury was to the left tibia. If the record is ambiguous, query the provider before choosing between S82.255S and S82.256S (unspecified).
4. Confirm fracture type is comminuted. The original radiology report or operative note must describe a comminuted pattern. If the type is undocumented, assign the unspecified fracture code instead.
5. Confirm the fracture was nondisplaced. The record must say so. If it is silent on displacement, ICD-10-CM defaults to displaced, which is S82.252S.
6. Code the residual condition first. ICD-10-CM Official Guidelines Section I.B.10 sequences the nature of the sequela first. Select the most specific code available, such as lower leg pain, deformity or limb-length discrepancy.
7. List S82.255S second. The injury code with the S character follows the residual condition code, unless the Tabular List directs otherwise.

Additional codes required when reporting S82.255S

S82.255S is never the only code on a sequela claim. ICD-10-CM Official Guidelines Section I.B.10 requires a code for the nature of the sequela, sequenced first, with S82.255S after it. Common residual-condition codes reported with S82.255S include:

• M79.662 (Pain in left lower leg) for residual chronic pain after a healed fracture
• M21.062 (Valgus deformity, not elsewhere classified, left knee) or the applicable M21 code for angular deformity from malunion
• M62.562 (Muscle wasting and atrophy, not elsewhere classified, left lower leg) when significant atrophy follows prolonged immobilization
• M21.762 (Unequal limb length (acquired), left tibia) or the applicable M21.7- code for leg-length discrepancy, when clinically documented
• M86.662 (Other chronic osteomyelitis, left tibia and fibula) or another M86 code the documentation supports, for osteomyelitis after an open fracture

Always select the most specific code the documentation supports. Confirm every supplementary code against the current CMS ICD-10-CM code files for the applicable fiscal year.

Payer requirements and claim submission for S82.255S

Sequela claims carry a heavier documentation burden than routine subsequent-encounter claims. Payers need to see that the original injury occurred, that healing is confirmed, and that the current treatment addresses the residual condition. For Medicare and most commercial payers, the claim must link the treatment plan to the specific sequela named in the code pairing.

Key payer expectations for S82.255S claims:

• The note must document when the original fracture occurred and reference prior treatment (surgery, casting, or conservative management).
• Imaging confirming fracture union should be on file and referenced in the current note.
• The current treatment plan must address the named sequela, not ongoing fracture management.
• Prior authorization requirements vary by payer and plan; never assume a sequela claim is covered by the original injury authorization.

A clearinghouse with eligibility checks and claim edits catches many errors before adjudication. Pabau offers clearinghouse submission via Claim.MD to thousands of US payers, with real-time eligibility checks. Understanding medical billing fundamentals helps practice staff interpret the edit messages that come back on rejected claims.

Common claim denial reasons for S82.255S

Denials on S82.255S claims cluster around four errors. Each is preventable with the documentation steps above.

Payers explain each rejected S82.255S claim with a CARC (Claim Adjustment Reason Code), and our denial code guide decodes each one. Diagnosis problems typically surface as CO-11, meaning the diagnosis is inconsistent with the procedure.

CO-16 means the claim lacks information or has a billing error. CO-50 appears when the payer does not consider the service medically necessary.

Physical therapy practices treating post-fracture rehab should also check their Medicare Administrative Contractor’s LCD for outpatient therapy. Those policies can add documentation requirements on top of the ICD-10-CM sequela rules.

How Pabau helps prevent denials on tibia fracture sequela claims

Without a pre-submission check, a sequela coding error usually surfaces only when the denial arrives. The coder then rechecks the chart, corrects the seventh character or the code order, and resubmits weeks later.

Pabau’s claims management software pre-fills each claim from the invoice and scrubs it for missing or invalid details before it goes to Claim.MD. Claim statuses and remittances flow back into Pabau, and denied claims are flagged for rework.

Billing teams get one dashboard for every S82 claim that needs attention, instead of chasing denials payer by payer. The provider note still has to document union and the residual condition, but fewer claims bounce back for avoidable errors.

Reduce claim denials on ICD-10 sequela codes

Pabau scrubs each claim for missing or invalid details before it goes to Claim.MD, then flags denied claims for rework. See how it works for orthopedic and physical therapy billing.

Book a demo

Conclusion

S82.255S is right only when four facts line up in the record: left side, comminuted pattern, documented nondisplacement, and a healed fracture. If any one is missing, query the provider before you code, because a sibling code or the D character will fit better.

When the facts do line up, the order on the claim decides whether it pays. List the residual condition first and S82.255S second, and make sure the note ties the two together.

Pabau’s Claim.MD clearinghouse integration checks claims before they leave the practice and tracks each one through to payment. Book a demo to see how it supports orthopedic and PT billing teams.

Continue your research

Need to understand how clearinghouse edits catch ICD-10 mismatches before denial? Clean claim submission standards explains what payers validate during adjudication and how edit checks prevent seventh-character errors.

Want to read the remittance behind a denied sequela claim? Electronic remittance advice covers ERA/835 remittance codes so billing teams can decode exactly why S82 claims were adjusted.

Want to see where sequela coding sits in the revenue cycle? Revenue cycle management in healthcare explains how diagnosis codes move from clinical documentation through to payment posting.

Frequently asked questions