ICD-10 Code S82.291J: Right tibia shaft fracture with delayed healing

Key takeaways

ICD-10 Code S82.291J covers an other fracture of the shaft of the right tibia at a subsequent encounter. The fracture was open, graded Gustilo type IIIA, IIIB, or IIIC, and healing is delayed.

Delayed healing is not nonunion. If the record says union has failed rather than slowed, the correct character is N, not J.

The 7th character J is one of 16 valid extensions for S82.291. Choose J only when the encounter is subsequent, the fracture is open Gustilo type III, and the provider documents delayed healing.

S82.291J is billable and specific. It is valid under the FY2026 ICD-10-CM edition, which applies to encounters on or after October 1, 2025.

Practice management software like Pabau links note fields for laterality, fracture type, and healing status to the claim. Coders then work from a complete record instead of chasing addenda.

ICD-10 Code S82.291J: definition and clinical description

ICD-10 Code S82.291J reports a right tibial shaft fracture that was open and graded Gustilo type III, and that is now healing slowly. The healing status built into the code is delayed healing, not nonunion. Coders who read the J extension as failed union land on the wrong character.

The full official description reads: Other fracture of shaft of right tibia, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing. It is a billable, specific ICD-10-CM code.

The code is valid under the FY2026 edition, which applies to encounters on or after October 1, 2025. The CDC/NCHS ICD-10-CM web tool returns the same descriptor.

The trap in this family is the J and N pair, since both cover a subsequent encounter for an open type III fracture. The bone and the side are identical. Only the documented healing status separates them, and only the treating provider can supply it.

S82.291J code details at a glance

Breaking down S82.291J character by character

Each segment of the code answers one clinical question. Reading the code from left to right shows exactly which piece of documentation supports it.

Understanding the 7th character J in S82.291

The parent code S82.291 (Other fracture of shaft of right tibia) is not billable on its own. It needs a 7th character to become a valid, specific code. That single character carries three pieces of clinical information at once: the encounter type, the open or closed status, and the healing status.

Character J means subsequent encounter plus open fracture type IIIA, IIIB, or IIIC plus delayed healing. The near neighbors are where denials start. N shares the encounter and the Gustilo grade but reports nonunion. H reports delayed healing in a lower-grade open fracture, and F reports routine healing.

The letters I, L, and O never appear as 7th characters. The sequence therefore skips from H to J, and again from M to N, which leaves 16 valid extensions for S82.291.

Delayed healing vs nonunion: the distinction that sets the 7th character

Delayed healing means the fracture is still progressing toward union, only slower than the expected timeline for that injury. Nonunion means healing has stopped and will not finish without intervention. They are different clinical states, and they point to different 7th characters.

• Delayed healing (G, H, J): callus formation continues, but the timeline has slipped. Management usually means continued immobilization, a change in weight bearing, or bone stimulation.
• Nonunion (K, M, N): the provider records that union has failed, as S82.232M does for a lower-grade open shaft fracture. Management often escalates to revision fixation, bone grafting, or biologic adjuncts.
• Malunion (P, Q, R): the fracture healed in a poor position, which is what S82.155P reports after a tibial tuberosity fracture. Here the clinical problem is alignment rather than the rate of healing.

ICD-10-CM sets no week count for either state, so the provider’s own wording controls the character. Phrases such as slow to heal, delayed union, or healing behind schedule point to the J character. Wording such as failed union or established nonunion moves the encounter to N instead, the character S82.242N carries for a spiral shaft fracture.

The distinction also changes what the payer expects to see. A delayed healing claim usually sits alongside continued follow-up and imaging. A nonunion claim tends to sit alongside surgical intervention, so a J code paired with a revision procedure invites a records request.

Gustilo open fracture classification and ICD-10 coding

The Gustilo-Anderson classification is the standard for grading open long-bone fractures. Its three high-severity grades (IIIA, IIIB, IIIC) map onto the same 7th character options in the S82 code family.

The distinction matters because payers may audit claims where the Gustilo grade sits oddly next to the procedure codes billed. Guidance from the CMS ICD-10 codes page reinforces that every coded diagnosis needs supporting clinical documentation.

The Gustilo grade must be assigned by the operating surgeon at the time of initial debridement. Coding staff cannot infer the grade from a wound description alone. Clinical documentation tools with a fixed field for the grade keep it where the coder can find it, even in high-volume trauma caseloads.

When to use S82.291J: subsequent encounter coding rules

The ICD-10-CM Official Guidelines for Coding and Reporting define when each encounter designation applies. The test is the phase of care, not the number of visits so far.

Initial encounter (A, B, C) covers the period of active treatment. That includes the emergency department visit, the surgical admission, and follow-up visits while active fracture treatment continues. This holds even when a different provider takes over, so it is not limited to the first calendar visit. S59.229A uses the same A character on a closed physeal fracture.

Subsequent encounter (D through R) applies once active treatment ends and the patient is in the healing or recovery phase. Follow-up visits, cast changes, hardware checks, and rehabilitation monitoring during this phase all take a subsequent character. S52.529D shows the routine-healing version of that character.

Sequela (S) applies to a condition that arises as a direct result of the fracture, after the fracture itself has resolved. S59.199S is the same character applied to a later physeal fracture problem.

For ICD-10 Code S82.291J specifically, use it when all of the following are documented:

• The fracture is of the shaft of the right tibia, not the fibula and not the left tibia
• The fracture was open, graded Gustilo type IIIA, IIIB, or IIIC at initial surgical evaluation
• The patient is now at a subsequent encounter, so active treatment has concluded
• The provider describes healing as delayed rather than routine, failed, or malaligned

Orthopedic practices managing these cases often run fracture follow-up on sports medicine software. Those systems flag the documentation still outstanding at each visit, which keeps the encounter character defensible.

Where the code sits in the ICD-10-CM hierarchy

ICD-10 Code S82.291J sits at the seventh-character level of the ICD-10-CM code tree. Each parent level carries notes and instructions that apply to every child code beneath it.

Anything the tabular list attaches at the S82 or S82.2 level also governs S82.291J. That includes the 7th character requirement and the excludes notes covered below.

Related ICD-10 codes for S82.291J

Healing status, fracture type, and laterality decide which neighboring code applies. The table below covers the codes most often confused with S82.291J.

Neighboring shaft codes follow the same structure with a different fracture line. S82.222E pairs a displaced transverse shaft fracture with a routine-healing subsequent character. Use the AAPC Codify lookup to cross-reference adjacent S82 codes.

Includes, excludes, and coding notes

The ICD-10-CM tabular list carries several instructional notes at the S82 category level. Check each one before assigning any code in this family.

Includes note (S82 level): fracture of malleolus.

Excludes1 note (S82 level): an Excludes1 entry is a true exclusion. It can never be reported with a code from this category for the same encounter.

• Traumatic amputation of lower leg (S88.-)

Excludes2 notes (S82 level): an Excludes2 entry is a different condition, and you may report it alongside S82.291J when both are documented.

• Fracture of foot, except ankle (S92.-)
• Periprosthetic fracture around internal prosthetic implant of knee joint (M97.1-)
• Periprosthetic fracture around internal prosthetic ankle joint (M97.2-)

External cause codes: chapter 19 guidance asks for a secondary code from chapter 20. That code identifies the mechanism of injury when the record documents it. It matters most for the high-energy trauma that produces Gustilo type III fractures.

The WHO ICD-10 browser gives the international classification context. US coders should still work from the ICD-10-CM version maintained by CMS and NCHS.

No aftercare Z codes: fracture aftercare is not reported with the Z47 or Z51 aftercare codes. The guidelines instead direct you to the acute fracture code with the subsequent encounter 7th character, which is exactly the role S82.291J plays.

Documentation requirements for accurate coding

Every element of ICD-10 Code S82.291J needs support in the physician record. A payer can request the chart for any element the code asserts. Here is what the record must contain.

• Laterality confirmed: the note must say right tibia. The left side maps to S82.292J, and tibia without a side does not support this code.
• Fracture site specificity: the shaft must be identified. Proximal and distal tibia fractures fall under other code families.
• Fracture type: the operative or emergency record must show this was an open fracture, classified with Gustilo-Anderson criteria. Open wound on its own is not enough.
• Gustilo grade documented by the surgeon: the operating surgeon must specify IIIA, IIIB, or IIIC in the operative note. Coders cannot assign the grade themselves.
• Encounter type confirmed: the visit must follow the end of active treatment. Progress notes should show ongoing monitoring of the healing fracture.
• Delayed healing stated in the note: the provider must describe healing as slower than expected. If the note instead says union has failed, the encounter belongs to N, and if it says routine progress, it belongs to F.

Practices running a physical therapy EMR can build note templates for these visits. The template prompts for each element at every subsequent fracture visit, so nothing is missing at billing.

Approximate synonyms and clinical terminology

Records, radiology reports, and operative notes often use other wording that still maps to S82.291J. These are the phrasings coders should recognize.

• Other fracture of shaft of right tibia, subsequent encounter, open fracture type IIIA with delayed healing
• Other fracture of shaft of right tibia, subsequent encounter, open fracture type IIIB with delayed healing
• Other fracture of shaft of right tibia, subsequent encounter, open fracture type IIIC with delayed healing
• Delayed union of open right tibial shaft fracture (Gustilo III)
• Slow healing open tibial shaft fracture, right, subsequent visit
• Compound fracture right tibia shaft, healing behind schedule, follow-up

Watch the wording closely when a report hedges. Terms like poor callus or limited interval healing describe delayed healing, while established nonunion or atrophic nonunion do not. Where a report reads both ways, query the provider rather than pick the character yourself.

Billing and reimbursement considerations

An ICD-10-CM code carries no payment rate of its own. Payment follows the CPT or HCPCS service billed with it, and S82.291J is what establishes medical necessity for that service.

• Consistency across the claim: the healing status in the diagnosis should match the service billed. Continued monitoring and imaging fit J, while revision surgery usually points to a nonunion code.
• Sequencing: report the fracture code first for a visit centered on the fracture, then add the external cause code and any complication codes.
• Records on request: keep the operative note with the Gustilo grade accessible. It is the document that supports the type III part of the code.
• Watch the encounter shift: once the provider documents failed union, later visits move to N, and continuing to bill J invites recoupment.

Payer policies differ on what counts as adequate wording for delayed healing, so check the medical policy for your largest plans. A short internal coding rule, agreed with your orthopedic team, saves repeated physician queries later.

How Pabau supports accurate ICD-10 coding for orthopedic practices

Fracture follow-up creates a long tail of subsequent encounter claims. Most denials in that category come down to a note that never named the healing status. Today many practices handle it by hand, with coders emailing physicians for addenda weeks after the visit.

Practice management software like Pabau closes that loop at the point of care. Pabau’s claims management software carries the coded visit straight into the claim. Laterality, fracture type, and healing status travel from the consultation into the billing record without re-entry. Coders read the note beside the code and confirm J before the claim goes out.

Structured note templates in Pabau prompt for the Gustilo grade at debridement and for healing status at every review. The chart then answers the payer’s question the first time, which shortens the wait between the visit and the paid claim.

Streamline orthopedic and trauma billing with Pabau

Pabau's claims management tools help orthopedic practices capture the documentation each 7th character needs. Denials fall, and subsequent encounter billing stays consistent across multi-visit fracture cases.

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Conclusion

S82.291J belongs to one narrow scenario. The right tibial shaft fracture was open at Gustilo type III, the encounter is subsequent, and healing is slow rather than failed.

Get the surgeon’s grade recorded at debridement, get the healing status named in each follow-up note, and confirm laterality every time. Miss any one of those and the claim is hard to defend on audit.

The J and N mix-up is the one to guard against, because both codes describe the same bone, side, and encounter type. Pabau builds those documentation prompts into the clinical workflow, so coders work from a complete record instead of chasing addenda. To see how Pabau handles multi-visit fracture billing, book a demo.

Continue your research

Coding a subsequent visit in the same shaft family? ICD-10 Code S82.222E walks through the same encounter and healing-status logic for a displaced transverse tibial shaft fracture.

Need the routine-healing version of a subsequent encounter? ICD-10 Code S99.101D shows how the D character works on a metatarsal physeal fracture.

Coding nonunion in a nearby bone? ICD-10 Code S92.145K covers a talar dome fracture that has failed to unite.

Need structured lower-limb assessment documentation? Ottawa ankle rules clinical reference provides a comparison framework for lower-extremity injury evaluation.

Looking for post-fracture rehabilitation documentation tools? Return-to-running physical therapy protocol covers structured rehabilitation milestones relevant to tibial fracture recovery.

Frequently asked questions