ICD code S82.441J – Displaced spiral right fibula shaft fracture, open type III, delayed healing

Key takeaways

S82.441J codes a displaced spiral fracture of the right fibula shaft at a subsequent encounter. The fracture was open, Gustilo type IIIA, IIIB or IIIC, and healing is delayed.

J needs three facts in the record: a type III open fracture, completed active treatment, and delayed healing stated by the provider.

F covers the same fracture healing on schedule, and G covers a closed fracture with delayed healing. N and R cover nonunion and malunion.

An open fracture with no Gustilo type documented defaults to the type I or II character, H, so query the provider before you assign J.

Pair J with follow-up E/M codes or fibula CPT codes such as 27780, 27781 and 27784. Tibial shaft codes need their own tibia diagnosis.

Pabau’s practice management software keeps the operative note, imaging and diagnosis code on one record, so coders can confirm the Gustilo grade first.

ICD-10 Code S82.441J: Code at a glance

ICD-10 Code S82.441J reports a displaced spiral fracture of the right fibula shaft at a subsequent encounter.

The original fracture was open, Gustilo type IIIA, IIIB or IIIC, and the provider has documented delayed healing. The code sits in category S82, fracture of lower leg, including ankle. Its hierarchy runs S82, S82.4, S82.44 and S82.441, with J added as the 7th character.

The CMS FY 2027 ICD-10-CM code files list S82.441J as a valid, billable code from October 1, 2026. The CDC/NCHS ICD-10-CM web tool can be used to confirm the entry. Check the effective date of any code after each October 1 update before you submit claims.

Full code descriptor breakdown for S82.441J

Each segment of the S82.441J descriptor carries a specific coding meaning. Misreading any one of them leads to the wrong code.

• S82 – Fracture of lower leg, including ankle. The category for tibia, fibula and malleolar fractures.
• S82.4 – Fracture of shaft of fibula. Separates shaft injuries from fractures of the lateral malleolus alone (S82.6-).
• S82.44 – Spiral fracture of shaft of fibula. The fracture line twists around the bone, usually after a rotational force.
• S82.441 – Displaced spiral fracture of shaft of right fibula. The 6th character 1 records both displacement and the right side. S82.442 codes the left fibula, and S82.444 the nondisplaced right fibula.
• J (7th character) – Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing. Active treatment has ended, and the provider has documented slower-than-expected healing.

The official descriptor reads in full as follows.

Displaced spiral fracture of shaft of right fibula, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing.

Change any one element and the code changes. A nondisplaced fracture, a closed fracture, the left side or a different healing status each takes a different code.

Understanding the 7th character J in ICD-10 fracture codes

The 7th character J reports a subsequent encounter for an open fracture of Gustilo type IIIA, IIIB or IIIC with delayed healing. Section I.C.19.c.1 of the ICD-10-CM Official Guidelines for Coding and Reporting defines subsequent care as encounters after active treatment, during the healing or recovery phase.

Category S82 uses all 16 characters below. The open fracture designations follow the Gustilo classification, as the S82 category note states.

Assign J only when the record shows all three facts: a type III open fracture, completed active treatment and documented delayed healing. When an open fracture has no Gustilo type recorded, the guidelines direct coders to the type I or II character. Here that is H, so query the provider for the grade instead of defaulting.

S82.441J vs similar codes: Choosing the right one

The S82.441 family splits on side, open fracture grade, encounter type and healing status. Payers compare the submitted code with the clinical record, so each element has to match the documentation.

The AAPC Codify ICD-10-CM lookup gives crosswalk details for the full S82.441 family. That helps when you check a code against payer edits.

Excludes notes and what S82.441J does not cover

Category S82 carries one Excludes1 note and three Excludes2 notes. An Excludes1 condition is never coded together with S82. An Excludes2 condition is not part of S82, but the patient can have both, so each gets its own code.

• Excludes1 (S82): Traumatic amputation of lower leg (S88.-). Do not report S82.441J with an S88 code for the same injury.
• Excludes2 (S82): Fracture of foot, except ankle (S92.-). Code a foot fracture separately with S92.
• Excludes2 (S82): Periprosthetic fracture around internal prosthetic ankle joint (M97.2). A fracture around an ankle replacement takes M97.2.
• Excludes2 (S82): Periprosthetic fracture around internal prosthetic implant of knee joint (M97.1-). A fracture around a knee replacement takes M97.1-.
• Excludes2 (S82.4): Fracture of lateral malleolus alone (S82.6-). A lateral malleolus fracture without a shaft fracture is coded in S82.6.

S82.441J also does not include a tibial fracture. Type III open fibula shaft fractures frequently occur with a tibial fracture from the same injury, so code each bone separately. Sequence multiple fractures by severity, as the guidelines require.

Clinical context: Open type III fibula shaft fractures and delayed healing

An open type III spiral fracture of the fibula shaft usually follows high-energy trauma. Typical causes include a motor vehicle crash, a fall from height or a crush injury. The Gustilo classification grades open fractures by wound size, soft-tissue damage and vascular injury.

• Type IIIA: Extensive soft-tissue laceration or a high-energy injury, but enough soft tissue remains to cover the bone.
• Type IIIB: Extensive soft-tissue loss with periosteal stripping and exposed bone, usually needing a flap or other coverage procedure.
• Type IIIC: An open fracture with an arterial injury that needs repair.

Delayed healing means the fracture is uniting more slowly than expected but has not been called a nonunion. Type III injuries carry a higher risk of it, because soft-tissue damage, contamination and infection can all slow bone repair. The provider decides that healing is delayed, and the note has to say so.

The encounter sequence maps to four ICD-10-CM phases for orthopedic workflows and physical therapy practice management:

1. Initial encounter (C): Emergency care, debridement, antibiotics, stabilization and any planned return to surgery for further debridement or coverage. Every encounter during active treatment keeps C.
2. Subsequent encounter, routine healing (F): Follow-up after active treatment while the fracture heals on schedule.
3. Subsequent encounter, delayed healing (J): Follow-up once the provider documents slower-than-expected union.
4. Complications or late effects (N, R or S): Nonunion, malunion or a sequela documented later in recovery.

The move from C to a subsequent character follows the phase of care, not the provider. A new surgeon who sees the patient after active treatment still reports J, provided the record documents delayed healing.

Documentation requirements for S82.441J

S82.441J needs six documentation elements to hold up on audit. Missing any one of them gives a payer grounds for denial or recoupment. Meeting clean claim requirements for these follow-up visits starts in the clinical record, not the billing system.

• Open fracture and Gustilo grade: The emergency or operative note states that the fracture was open and grades it IIIA, IIIB or IIIC. Without a grade, coding defaults to the type I or II character.
• Displacement and spiral pattern: Imaging or the provider note describes a displaced spiral fracture of the shaft. A fracture not described as displaced or nondisplaced is coded as displaced.
• Laterality (right side): The note names the right fibula. Entries such as “leg fracture” or “fibula fracture” with no side need a provider query before coding.
• Completed active treatment: The record shows that debridement, stabilization and wound coverage are finished, and that this visit is follow-up care.
• Delayed healing, in the provider’s words: The provider states “delayed healing” or “delayed union”, supported by imaging or the exam. Coders cannot assign it from an X-ray report alone.
• No nonunion or malunion: If the provider documents either one, the 7th character changes to N or R.

Commonly paired CPT codes for S82.441J encounters

The CPT codes reported with S82.441J depend on what the provider does at the follow-up visit. Fracture care codes are billed once, at definitive treatment. At a J visit they matter mainly because their global period decides whether the visit is separately payable.

Global surgery rules decide what is payable at a J visit. E/M visits inside the global period of the fracture surgery are bundled, unless an unrelated problem supports modifier 24. A related return to surgery in that period takes modifier 58 when it was staged, or 78 when it was unplanned.

Pabau’s claims management software records ICD-10-CM codes at the encounter level and checks them against the procedure codes before submission.

Payer requirements and prior authorization

Medicare generally does not require prior authorization for fracture follow-up visits coded with S82.441J, but every visit needs documented medical necessity. The note should say why the visit happened, such as monitoring delayed union, reviewing the wound or changing the treatment plan.

Delayed-healing visits draw more scrutiny than routine follow-up, because they often lead to imaging, bone growth stimulators or further surgery. Meeting medical billing compliance standards means checking each payer’s policy before the visit rather than after the denial.

• Medicare Part B: Covers medically necessary follow-up visits with no routine prior authorization. Visit counts well beyond expected healing timelines can draw review.
• Medicare Advantage plans: Policies vary by plan. Some require authorization for specialist visits, advanced imaging or a return to surgery.
• Bone growth stimulators: Confirm coverage before the order. Medicare’s policy for osteogenesis stimulators ties coverage to criteria such as documented nonunion, so delayed healing alone may not qualify.
• Commercial payers: Use the payer’s prior authorization lookup tool or call provider relations. Some payers limit how often imaging can be repeated during healing.

Common claim denials for ICD-10 Code S82.441J and how to resolve them

ICD-10 Code S82.441J denials cluster around five causes, and each has a specific correction. Pabau routes corrected claims through electronic claims via Claim.MD, which returns CARC codes and ERA data so billing teams can spot patterns across encounters.

Reviewing denial management workflows across the claim lifecycle helps orthopedic practices catch these patterns before they repeat. The electronic remittance advice (ERA/835) from each payer carries the CARC codes above. Compare them with the submitted ICD-10-CM data to see whether a denial came from the code or from the note behind it.

When to switch from S82.441J: Coding for complications

S82.441J fits only while the provider documents delayed healing of the type III open fracture. Five developments change the code.

• Nonunion (switch to S82.441N): The provider documents that the fracture has failed to unite. Change J to N from that encounter forward, and never infer nonunion from imaging alone.
• Malunion (switch to S82.441R): The fracture heals in an abnormal position, and the provider states “malunion” in the record. R replaces J from the date it is documented.
• Complication of the surgical repair: Infection around fixation hardware or a failed implant takes a complication code from the T84 category instead.
• New injury to the same site: A new fracture restarts the sequence with an initial encounter character.
• Sequela (S82.441S): A late effect after healing, such as post-traumatic stiffness, is coded first, followed by S82.441S.

The CMS ICD code lists and ICD List offer searchable references for checking the S82.441 characters when complications are documented.

How Pabau keeps the Gustilo grade tied to every follow-up claim

Open fracture coding goes wrong when the grade lives in one note and the healing status in another. The emergency note says type IIIB, and the follow-up note weeks later says “slow to heal”. A coder who sees only the second note sends the claim as G or H.

Pabau, the practice management platform we build for medical and multi-specialty practices, keeps the operative note, imaging reports and diagnosis codes on one patient record. Coders can check the original Gustilo grade before they choose a 7th character. Structured note templates prompt the provider to record healing status at every follow-up.

Claims then go out through the claims management module and the Claim.MD clearinghouse. Remittance data returns to the same record, so your team can see which fracture claims came back and fix the documentation behind them. Our medical billing overview explains how the full cycle fits together.

Keep open fracture follow-up claims clean

Pabau links clinical notes, ICD-10-CM codes and Claim.MD submission on one record, so your team catches 7th character errors on S82.441J first.

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Conclusion

S82.441J describes a narrow situation: a severe open fracture, past active treatment, that is healing more slowly than it should. Every part of that description has to be in the record. The Gustilo grade is the part most often lost, because another provider wrote it weeks earlier.

Build the follow-up note around the grade, the phase of care and the healing status. The 7th character then becomes a lookup rather than a judgment call. Skip that step, and claims drift to G or H and fail on audit. Book a demo to see how Pabau keeps fracture documentation and claims on one record.

Continue your research

Need to understand how clearinghouse rejections differ from payer denials? How the Claim.MD clearinghouse works explains the rejection-to-denial pipeline and how to resolve each stage.

Looking for a framework to reduce recurring denial patterns across your practice? Revenue cycle management fundamentals covers the end-to-end process from code capture to remittance reconciliation.

Want to see how ICD-10-CM codes map to superbill and claim submission workflows? What is a superbill explains how diagnosis codes are captured at the point of care and flow through to the clearinghouse.

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