ICD code S92.144K – Nondisplaced right talar dome fracture with nonunion

Key takeaways

ICD-10 Code S92.144K covers a nondisplaced dome fracture of the right talus at a subsequent encounter where nonunion is documented, distinct from routine follow-up.

The 7th character K means nonunion specifically. Character D means routine healing and G means delayed healing. These are not interchangeable.

The 6th character 4 means nondisplaced and right-sided. A left talar dome nonunion is S92.145K, and S92.146K is only for records that never state the side.

Pabau, the practice management platform we build, scrubs each claim for missing or invalid details before it reaches the payer, then tracks it to payment.

ICD-10 Code S92.144K: Official descriptor and billable status

ICD-10 Code S92.144K is a valid, billable ICD-10-CM code for fiscal year 2027. Its full official descriptor is: Nondisplaced dome fracture of right talus, subsequent encounter for fracture with nonunion.

The code is confirmed active in the CDC/NCHS ICD-10-CM web tool and in the CMS ICD-10-CM code files. It belongs to chapter 19 (Injury, poisoning, and certain other consequences of external causes) and category S92 (Fracture of foot and toe, except ankle).

Anatomy of the code: Breaking down each character

Every character in S92.144K carries a distinct clinical meaning. Reading the code left to right produces the full clinical picture without referencing the descriptor text.

The 6th character carries both displacement and laterality. Values 1 to 3 mean displaced (right, left, unspecified), and 4 to 6 mean nondisplaced in the same order.

Selecting 4 when imaging shows displaced fragments is a coding error that payers and auditors identify quickly. The two questions below show how the record narrows the talar dome family to one code.

Understanding the K suffix: Subsequent encounter for fracture with nonunion

The 7th character K marks a subsequent encounter where the fracture has failed to unite. Routine follow-up during normal healing takes D instead, and mixing the two causes the most denials in orthopedic fracture billing.

According to the ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.c, the 7th character for fractures follows a defined set of meanings. Each character is mutually exclusive and must match the clinical status of the fracture at the time of the visit being coded.

Nonunion means the fracture has not healed and is unlikely to do so without intervention. Delayed healing (G) is a slower version of normal healing. Coding K when the record shows delayed but progressing union is an overcoding error. It misrepresents the clinical picture and exposes the practice to audit risk.

Nondisplaced talar dome fractures: Clinical context

The talus sits between the tibia and fibula above and the calcaneus below. It carries body weight from the leg into the foot. Its dome is the upper, cartilage-covered surface that forms the ankle joint with the tibia.

Talar dome fractures most often follow an ankle sprain or twisting injury, when the dome is compressed or sheared against the tibia or fibula. Many are osteochondral injuries that damage both the cartilage and the bone beneath it. Nondisplaced ones are easy to miss on plain X-rays, so CT or MRI often confirms them.

Nonunion is a particular risk at this site. Most of the talus is covered by cartilage, so blood reaches it through a limited number of small vessels. That fragile supply is why a dome fragment can fail to unite even when it never moved. Smoking, diabetes and early weight-bearing add to the risk.

Nondisplaced talar dome fractures are usually managed without surgery at first, with a cast or boot and protected weight-bearing. That conservative path generates a series of subsequent encounters for boot changes, weight-bearing progression, and imaging review. Those are exactly the visits where encounter type selection becomes a billing risk.

• Persistent ankle pain after a sprain is the classic presentation. Deep ankle pain, swelling or catching weeks after the injury often prompts the imaging that documents the nonunion.
• Imaging at each subsequent visit must be reviewed for healing. A persistent fracture line or an unhealed dome fragment on CT or MRI at the expected interval supports a K suffix.
• Laterality is built into the code. S92.144K is for the right talus only. Use S92.145K for the left talus, and S92.146K only when the record never states the side.
• Osteochondritis dissecans is not a fracture code. If the record describes a talar dome lesion without a traumatic fracture, it codes to M93.27- (osteochondritis dissecans of the ankle and foot) instead.

Adjacent and commonly confused codes

ICD-10 Code S92.144K sits within a tightly grouped family of talus fracture codes. A wrong laterality, displacement or encounter type character is the usual documentation-to-code mismatch for these injuries.

The most frequent swap is with S92.145K, the same nonunion in the left talus. The table below maps the codes most often confused with S92.144K.

Documentation requirements for ICD-10 Code S92.144K

Payers reviewing a claim billed with ICD-10 Code S92.144K will look for specific clinical evidence in the visit note. Missing any of these elements is a common path to denial.

• Confirmation of subsequent encounter: the note must establish this is not the first visit for active treatment of the fracture. The original injury date and prior treatment history should be referenced.
• Nonunion documented by imaging: an X-ray or CT report showing absence of bridging callus, persistent fracture line, or fibrous union at the expected healing interval. The radiologist’s report or the treating clinician’s interpretation must state nonunion explicitly or describe findings consistent with it.
• Absence of displacement: the record must not describe displaced fragments. If imaging at the follow-up visit now shows displacement that was absent initially, the displacement status may need re-evaluation.
• Right side and talar dome site documented: the record must place the fracture on the dome of the right talus. If it names the left talus, use S92.145K. If the fracture is in the calcaneus, the code comes from S92.0- instead.
• Injury date vs visit date: the original fracture date should appear in the note. This establishes the timeline supporting a nonunion designation at this point in recovery.

Nonunion vs delayed healing: The documentation distinction

Orthopedic surgeons and physiatrists sometimes use “delayed union” and “nonunion” interchangeably in clinical notes. For coding, they are not interchangeable.

Delayed healing (7th character G) means healing is occurring more slowly than expected but the fracture is progressing toward union. Nonunion (7th character K) means healing has stopped or failed.

When the provider’s note is ambiguous, query before coding. Using K when the provider meant G creates an overcoding risk. Using G when the record supports K may understate the clinical complexity and affect reimbursement for further treatment.

Associated CPT procedure codes

Subsequent encounters for a talar dome fracture with nonunion typically involve fracture management, re-imaging and, when conservative care fails, surgery. The CPT codes below are commonly billed alongside ICD-10 Code S92.144K. Verify NCCI bundling edits for the current year before submission.

When CT confirms the nonunion, the scan bills as 73700. That radiology report is also the document a payer asks for first when it questions the K suffix, so keep it attached to the encounter.

Payer and Medicare billing requirements

Medicare Part B and most commercial payers apply medical necessity criteria to subsequent fracture management visits. Submitting ICD-10 Code S92.144K does not automatically establish medical necessity. The clinical record must justify why this follow-up visit was required and what clinical decision-making occurred.

• Medical necessity documentation: the note must record the clinical findings at the visit, such as pain, range of motion, imaging review and the treatment decision. A note that simply states “fracture follow-up” without clinical content may be denied for lack of medical necessity.
• Frequency limitations: Medicare and many commercial plans limit the number of reimbursable subsequent fracture management visits within a global period. Practices should verify the applicable global period for the CPT code billed at the initial encounter.
• Prior authorization triggers: surgical intervention for nonunion (such as bone grafting or internal fixation) commonly requires prior authorization. The nonunion designation in the ICD-10 code should be supported before the authorization request is submitted.
• LCD verification: local coverage determinations (LCDs) issued by Medicare Administrative Contractors (MACs) govern specific medical necessity criteria for fracture management in each jurisdiction. Verify the applicable LCD for your MAC before generalizing coverage rules.

Common claim denial reasons and how to avoid them

Claims billed with ICD-10 Code S92.144K face a predictable set of denial patterns. Most trace back to one root cause. The 7th character was selected without enough documentation to support it.

Each denial comes back with a payer reason code. Our reference on denial codes for coders explains what the common ones mean and how to answer them.

Structured denial management workflows shorten the time between a denial and a corrected resubmission. Practices that track denial reasons by code family spot recurring documentation weaknesses before an auditor does.

The clean claim criteria for these fracture codes include correct encounter type, laterality, and a supporting documentation reference. Checking all three while coding costs far less than reworking a denial.

Coding tips and best practices for S92.144K

S92.144K is usually misapplied at three points: laterality, encounter type and the global period. These habits catch each one before the claim goes out.

• Match laterality to the documentation at every visit. If earlier visits were coded as unspecified talus (S92.146K) but the progress notes now name the right ankle, move to S92.144K at the next visit. ICD-10-CM guidelines require coding to the highest degree of specificity the documentation supports at the time of the encounter being coded.
• Build a transition trigger into your EHR template. Orthopedic follow-up note templates should include a prompt asking the provider to state current healing status (routine / delayed / nonunion) and reference imaging. This single field prevents the most common encounter-type coding error.
• Audit the global period before submitting subsequent fracture management CPT codes. The global surgical period attached to the initial treatment CPT code may cover some follow-up services. Billing a separate E&M within the global period without a modifier is a common NCCI violation.
• Document the transition from initial to subsequent encounter clearly. The first visit for active treatment of the fracture uses 7th character A (or B for an open fracture). Later visits use D, G, K, P or S, depending on healing status. A patient may switch providers mid-treatment. If active treatment had already begun elsewhere, the new provider’s first visit is still a subsequent encounter.
• Verify code validity for the fiscal year being billed. ICD-10-CM is updated annually on October 1. Always confirm S92.144K remains active in the fiscal year applicable to the date of service on the claim.

How Pabau keeps S92.144K claims clean from visit to payment

A talar dome nonunion can run through months of boot changes, scans and surgical decisions. Each visit is a fresh chance to send the wrong 7th character or a claim with no imaging behind it. Many orthopedic and physical therapy teams still catch those slips only when the denial arrives.

Pabau moves that check to the front of the process. Its claims software for orthopedic practices scrubs each claim for missing or invalid details before it leaves Pabau. Through the Claim.MD clearinghouse integration, it verifies coverage before the visit and transmits 837P claims to thousands of US payers.

Electronic remittance advice flows back into Pabau and settles payments against the claims they belong to. A rejected claim shows its reason, so your billing team corrects the encounter type and resubmits the same day.

Reduce fracture claim denials with Pabau

Pabau checks coverage before the visit, scrubs each claim before it leaves, and settles payments from remittance files. Orthopedic and sports medicine practices submit cleaner fracture claims and rework fewer denials.

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Conclusion

S92.144K is only correct when four facts line up at the same visit. The fracture is on the right talar dome, it is nondisplaced, the encounter is subsequent, and imaging shows nonunion. If the note cannot support all four, query the provider before the claim goes out.

The cheapest fix is a healing-status prompt in every follow-up template, tied to a dated imaging reference. That one field turns the K suffix from a judgment call into a documented finding. It also protects the surgical claims that usually follow a talar dome nonunion.

A clean medical billing workflow keeps those checks in one place, from the coded visit to the paid claim. Book a demo to see how Pabau helps orthopedic practices get fracture follow-up claims paid on the first submission.

Continue your research

Want to understand how clearinghouse claim submission works? Medical claims clearinghouse guide explains the 837P transmission process from practice to payer.

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