ICD-10 Code S44.42XA: Musculocutaneous nerve injury, left arm
ICD-10 Code S44.42XA: Definition and billable status S44.42XA is the ICD-10 code...
Last Updated: August 13, 2026
Key takeaways
ICD-10 Code S82.443E covers a displaced spiral fracture of the shaft of an unspecified fibula.
The 7th character E means a subsequent encounter for an open Gustilo type I or II fracture with routine healing.
S82.443E leaves laterality unspecified, so use S82.441E for the right fibula and S82.442E for the left when the side is documented.
Documentation must confirm the fracture was open, the Gustilo grade, and that healing is on track before this character is assigned.
Practice management software like Pabau keeps encounter type, fracture grade, and healing status on one client record, so coders are not chasing paper.
ICD-10 Code S82.443E is a billable ICD-10-CM code for a displaced spiral fracture of the shaft of an unspecified fibula. It applies at a subsequent encounter, once active treatment is finished. The original wound must have been open and graded Gustilo type I or II, with healing on track.
Each qualifier in that descriptor is a separate coding decision: encounter type, fracture openness, Gustilo grade, healing status, and laterality. Change any one of them and the code changes with it. This reference works through all five under the FY2026 ICD-10-CM edition.
ICD-10 Code S82.443E: Quick reference
S82.443E is billable for encounters on or after October 1, 2025. The table below is the at-a-glance summary coders need before pulling it for a claim.
Full code description: breaking down S82.443E component by component
Every term in the S82.443E descriptor carries a coding consequence. Missing one changes the code.
Understanding the 7th character ‘E’ in ICD-10 Code S82.443E
The S82 category uses a standardized 7th character table that applies to every fracture code in the block. Character E is one of 16 possible values for S82.443. Selecting the wrong one is the most common claim error on these codes.
Character E is one of eight subsequent-encounter characters for open fractures (E, F, H, J, M, N, Q, R). It applies when the original fracture was open and graded Gustilo type I or II. The current visit has to be follow-up care with healing on track.
Confusing D with E is one of the most common 7th character errors on fracture claims. The same table drives femur codes such as S72.451K.
Open fracture classification: Gustilo types I and II
ICD-10-CM groups open fractures by the Gustilo-Anderson classification, and that grade decides the 7th character. Coders need the original operative note or emergency department record to confirm which type applied at the time of injury.
The criteria above come from the original 1976 classification by Gustilo and Anderson. You can confirm current guidance in the CDC ICD-10-CM tool.
The operative report from the initial encounter is the primary documentation source. If that chart says “open fracture” without naming a type, query the surgeon before you assign a character tied to Gustilo grade.
Subsequent encounter vs initial encounter: when to use S82.443E
A subsequent encounter applies once active treatment for the fracture is complete. The patient is then in routine care during the healing phase, per the CMS Official Guidelines. Use the wrong encounter character and the mismatch can trigger a medical necessity review.
- Initial encounter (A, B, or C): The patient is receiving active treatment for the fracture. That covers the emergency visit, the surgery date, and any follow-up still counted as active treatment.
- Subsequent encounter (D, E, F, etc.): Active treatment is complete. Patient is returning for cast changes, hardware checks, physical therapy progress visits, or wound care during the healing phase. This is where S82.443E applies.
- Sequela (S): Complications or late effects that persist after the fracture has healed, as in S92.909S.
A physical therapist running return-to-activity rehabilitation after fibula shaft repair is documenting under subsequent encounter codes. The injury and the surgery are behind the patient, so the visit belongs in the healing phase.
Pro Tip
Before assigning S82.443E, check three things in the prior encounter notes. The fracture was open at the time of injury, the Gustilo type was I or II, and active treatment has finished. Query the treating physician if the records cannot confirm all three.
Code hierarchy: where S82.443E sits in ICD-10-CM
The parent-child structure helps coders reach the correct code and spot when a more specific option exists. It also signals which tabular instructions apply at each level, the same way it does for femur codes like S72.431C.
- S00-T88 — Injury, poisoning, and certain other consequences of external causes
- S80-S89 — Injuries to the knee and lower leg
- S82 — Fracture of lower leg, including ankle
- S82.4 — Fracture of shaft of fibula
- S82.44 — Displaced spiral fracture of shaft of fibula
- S82.443 — Displaced spiral fracture of shaft of unspecified fibula
- S82.443E — Subsequent encounter, open fracture type I or II, routine healing
The S82 block includes a note to use an additional code to identify the associated open wound when applicable. Coders working on sports medicine or orthopedic claims should also check for any sequencing guidelines at the S82 category level before submitting.
Related ICD-10-CM codes for fibula shaft fractures
S82.443E sits in a family of codes that differ by displacement status, laterality, and 7th character. The table below maps the sibling codes coders meet most often on fibula shaft fracture claims. The same pattern runs through forearm codes such as S52.262K.
The S82.443D vs S82.443E distinction is the most common coding confusion on these claims. Both are subsequent encounter codes for displaced spiral fractures of the unspecified fibula shaft with routine healing. The single difference is whether the original fracture was open (E) or closed (D).
Billing and reimbursement guidance for S82.443E
S82.443E is accepted for reimbursement on professional and facility claims under the FY2026 edition. Use the CMS fee schedule lookup to confirm the paired CPT code’s rate by locality. Key billing points:
- Claim form: Submit on CMS-1500 (professional) or UB-04 (facility), as applicable to the setting.
- POA indicator: Present on Admission reporting applies in inpatient settings. Subsequent encounter visits are outpatient by definition, so POA usually does not apply. Verify it with your payer.
- Medical necessity: Pair S82.443E with a CPT code for the service rendered (wound care, cast application, office visit). The diagnosis must support the procedure.
- Payer policy: Some Medicare Administrative Contractors apply coverage policies to open fracture follow-up visits. Check the applicable LCD before billing.
Orthopedic and physical therapy practices carry most of the risk on these follow-up visits. Check that the 7th character matches the injury type recorded in the surgeon’s operative report.
Approximate synonyms and documentation language for S82.443E
ICD-10-CM recognizes a range of alternate descriptions that map to S82.443E. Clinical notes using any of these phrases can support this code, as long as the encounter type and healing status also match.
- Displaced spiral fracture of fibula shaft, unspecified side, open type I or II, follow-up visit, routine healing
- Follow-up for open spiral fibula shaft fracture with normal healing progress
- Subsequent care, displaced open spiral fracture of fibular diaphysis, type I or II wound, healing as expected
- Aftercare visit, spiral fibula fracture with Gustilo type I wound, routine recovery
- Displaced spiral fracture of fibula (unspecified laterality), open type II, subsequent encounter
The word “aftercare” in a note does not automatically mean a subsequent encounter. Confirm that active treatment is genuinely complete before you apply a subsequent encounter character.
Documentation requirements for S82.443E
Five documentation elements have to be present to support S82.443E. Missing any one of them invites a denial or an audit query.
- Fracture type confirmation: The original injury record must confirm the fracture was open, not closed. If this information is not available, the coder cannot justify using E over D.
- Gustilo grade: The original operative or emergency note must specify Gustilo type I or II. An unspecified open fracture type needs a physician query.
- Encounter type: Current note must indicate this is a follow-up or aftercare visit, not active treatment. A note stating “active fracture management” does not support subsequent encounter coding.
- Healing status: The provider note must confirm healing is progressing routinely. Any mention of delayed consolidation, nonunion risk, or unexpected pain changes the 7th character to H (delayed healing) or M (nonunion).
- Laterality: If the documentation specifies right or left fibula, use S82.441E (right) or S82.442E (left) instead. S82.443E is reserved for genuinely unspecified laterality.
Strong clinical record documentation at every encounter supports accurate coding, payer audits, and medical necessity reviews. The AAPC code reference carries additional notes for the S82 category.
How Pabau keeps 7th character documentation claim-ready
In most orthopedic and physical therapy practices, the four answers a 7th character needs are scattered. The operative report sits in one system and the follow-up note in another. A coder ends up chasing the Gustilo grade by phone before the claim can go out.
Pabau holds all of it on one client record. Custom clinical forms prompt the clinician for encounter type, fracture grade, and healing status while the patient is still in the room. Every follow-up visit is stamped on the same timeline, so the injury history stays attached to the current note.
When the coder opens that record, each 7th character question already has an answer in the chart. Pabau’s claims management tools then pull those recorded details into a pre-filled claim and track its status. Fewer queries go back to the surgeon, and fewer follow-up claims come back denied.
Keep fracture coding details on one record
Pabau’s clinical forms and client records capture encounter type, Gustilo grade, and healing status at the visit. Coders get what the 7th character needs without chasing paperwork.
Conclusion
S82.443E rests on five checks. The fracture was open, the Gustilo type was I or II, and active treatment has ended. Healing is routine, and laterality is genuinely undocumented. Change one of those and the 7th character changes with it.
The safest habit is to code the follow-up visit from the original operative note rather than from memory of the injury. When that note cannot answer one of the five, a query costs far less than a denial and a rebill.
Book a demo to see how Pabau keeps encounter type, fracture grade, and healing status together for every follow-up visit.
Continue your research
Coding a malunion instead of routine healing? S72.431R shows how the malunion character reshapes a femur claim.
Following a fracture that never united? S62.185K covers the nonunion documentation a wrist claim needs.
Working a hand fracture that stalled? S62.606K walks through nonunion reporting on a finger.
Assessing the ankle at a follow-up visit? Eversion stress test explains how to perform it and read the findings.
Screening for leg length differences in rehab? Supine to long sit test sets out the technique and what each result means.
Frequently asked questions
What is ICD-10 Code S82.443E?
ICD-10 Code S82.443E is a billable ICD-10-CM diagnosis code for a displaced spiral fracture of the shaft of an unspecified fibula. It applies at a subsequent encounter, where the original fracture was open and graded Gustilo type I or II. Healing must be routine. The code took effect October 1, 2025 under the FY2026 ICD-10-CM edition.
Is S82.443E a billable ICD-10-CM code?
Yes. S82.443E is a fully billable, specific ICD-10-CM code accepted for reimbursement on professional and facility claims. It is a specific code rather than a header, so it maps to one distinct clinical scenario. You can submit it as a primary or secondary diagnosis, depending on the claim context.
What is the difference between S82.443D and S82.443E?
S82.443D applies to a subsequent encounter for a closed fracture with routine healing. S82.443E applies to a subsequent encounter for an open fracture classified as Gustilo type I or II with routine healing. The fracture mechanism at the time of injury (open versus closed) is the sole differentiator. Both share the same displacement status, anatomical site, laterality, and healing qualifier.
What does the 7th character E mean in ICD-10 fracture codes?
In the S82 fracture category, the 7th character E means: subsequent encounter, open fracture type I or II, with routine healing. “Subsequent” signals that active treatment is complete and the patient is in the follow-up phase. “Type I or II” refers to Gustilo-Anderson classification. “Routine healing” confirms the fracture is consolidating as expected, with no delayed healing or nonunion.
When do you use subsequent encounter codes for fractures?
Subsequent encounter fracture codes apply once active treatment is complete. The patient is then back for routine care during healing, such as cast changes, hardware monitoring, or physical therapy follow-up. Per CMS Official Guidelines, the current visit decides the encounter type. The number of prior visits is irrelevant.
Is laterality specified in S82.443E?
No. The “unspecified” in S82.443E means laterality has not been documented. If the clinical record states the injured side is right or left, coders should use S82.441E (right fibula) or S82.442E (left fibula) instead. S82.443E is a last resort when laterality genuinely cannot be determined from available documentation.
What is a Gustilo type I or II open fracture?
Gustilo type I is an open fracture with a wound smaller than 1 cm caused by a low-energy mechanism with minimal soft tissue damage. Gustilo type II involves a wound between 1 and 10 cm without extensive soft tissue damage, periosteal stripping, or arterial injury. Both map to 7th character B at an initial encounter and character E at a subsequent encounter with routine healing. Gustilo type III is more severe, so it maps to C, F, J, N, or R, depending on encounter and healing status.
