ICD code S92.354P – Nondisplaced fracture of fifth metatarsal bone

Key takeaways

ICD-10 Code S92.354P describes a nondisplaced fracture of the fifth metatarsal bone in the right foot, coded at a subsequent encounter with malunion.

The 7th character P marks a subsequent encounter where the bone healed in a malunited position. K means nonunion and S means sequela.

Laterality sits in the 6th character. S92.354 is the right foot, S92.355 the left foot, and S92.356 an unspecified foot.

S92.154P is not a metatarsal code at all. It sits under S92.1, the talus, so reaching for it on a foot claim is a coding error.

Pabau’s claims management integration with Claim.MD supports ICD-10-coded claim submission, real-time eligibility checks, and ERA processing across thousands of US payers.

ICD-10 Code S92.354P: Full description and billable status

S92.354P is a billable, specific ICD-10-CM code valid for fiscal year 2026, which runs from October 1, 2025 through September 30, 2026. The CDC/NCHS ICD-10-CM coding tool lists it as active for the current fiscal year.

The CMS ICD-10-CM coding page publishes the annual update files that confirm active status. Verify code validity at the start of each fiscal year, because ICD-10-CM codes change every October 1.

Clinical description: What is a nondisplaced fifth metatarsal fracture?

A nondisplaced fifth metatarsal fracture is a break in the outer long bone of the foot where the fragments stay in normal alignment. The fifth metatarsal runs along the lateral edge of the foot, and most fractures cluster at its base.

A sudden inversion of the foot loads the peroneus brevis tendon and the bone gives way. That mechanism sits behind many injuries first treated as ankle sprains.

Nondisplaced means the fragments have not shifted meaningfully out of anatomical position. That one word separates S92.354 from the displaced code S92.351, and it changes both the treatment pathway and the claim.

Displacement status is a documentation element the coder cannot infer, so the imaging report or the physician note has to state it.

• Location: most fifth metatarsal fractures involve the base, either the styloid process (zone 1) or the metaphyseal-diaphyseal junction (zone 2)
• Nondisplaced: imaging shows the fragments still in normal alignment
• Common presentation: lateral foot pain, bruising, and tenderness over the fifth metatarsal base
• No avulsion-specific code: ICD-10-CM gives the metatarsals no separate avulsion or Jones fracture code, so both route to S92.35-

7th character extensions for S92.354: A through S

The 7th character records the stage of care, and S92.354 accepts seven of them. Picking the wrong one is a frequent cause of denial, because payers cross-check the character against the documented clinical findings.

Malunion vs nonunion: The clinical and coding distinction

Malunion (character P) and nonunion (character K) are frequently confused. Malunion means the fracture has healed, but the fragments consolidated in a position that deviates from normal anatomy. The bone is united, just united incorrectly. Nonunion means healing has not happened at all, and the fracture line persists.

Malunion of the fifth metatarsal can cause persistent lateral foot pain, gait changes, and trouble with footwear. X-ray or CT imaging usually confirms the malunited position. In post-fracture rehabilitation, documenting malunion clearly matters twice over. It shapes the treatment plan, and it supports the clinical rationale for continued visits.

Code hierarchy: Where ICD-10 Code S92.354P sits in the S92 structure

Reading the parent structure helps coders apply S92.354P correctly and find related codes quickly. The WHO ICD-10 classification browser holds the hierarchical framework that ICD-10-CM builds on.

S92.354 is not billable on its own, because it needs a 7th character before submission. Only the extensions A, B, D, G, K, P and S produce a valid, billable code.

Submitting S92.354 bare will be rejected at the clearinghouse. Read left to right, each character narrows the diagnosis. The breakdown below marks the position where one wrong digit changes the bone.

Excludes notes and coding defaults for S92.354P

Category S92 carries Excludes2 notes rather than Excludes1 notes. That means the excluded conditions are not part of a foot fracture, but a patient can have both at once. When that happens, report S92.354P and the excluded code together.

• Excludes2: fracture of ankle (S82.-)
• Excludes2: fracture of malleolus (S82.-)
• Excludes2: traumatic amputation of ankle and foot (S98.-)

Two ICD-10-CM defaults also apply across the whole category. A fracture that is not documented as displaced or nondisplaced is coded as displaced. A fracture that is not documented as open or closed is coded as closed. Both defaults push the claim away from S92.354P, so the note has to say nondisplaced for this code to hold up.

ICD-10-CM coding guidelines for S92.354P

The ICD-10-CM Official Guidelines for Coding and Reporting govern how subsequent encounter codes are applied. Several rules decide directly whether S92.354P is the right choice.

Initial vs subsequent encounter: The active treatment rule

Initial encounter, character A, does not mean first visit. It means the patient is receiving active treatment for the condition. A first specialist visit, a casting or splinting appointment, or surgical management all still take the A extension. The AAPC ICD-10-CM code reference applies this distinction consistently across the fracture families.

Subsequent encounter, characters D, G, K and P, applies once the patient reaches the healing or aftercare phase. Treatment has been established and the visit is about monitoring, rehabilitation, or managing a complication. S92.354P sits squarely there, because malunion is found or managed after the acute treatment phase.

Laterality: Right, left, and unspecified foot

The 6th character carries the side, so the same clinical picture produces three different codes. Only one of them holds up under review.

• S92.354P: right foot, nondisplaced, subsequent encounter with malunion
• S92.355P: left foot, nondisplaced, subsequent encounter with malunion
• S92.356P: unspecified foot, nondisplaced, subsequent encounter with malunion

Unspecified laterality should be rare on a fracture follow-up, because the treating clinician knows which foot was imaged. Payers read S92.356P as a documentation shortfall and often pend the claim. Query the record instead of defaulting to the unspecified code.

Documentation requirements for malunion encounters

Coders cannot select S92.354P on clinical assumption. The physician documentation has to state malunion or clearly support it. Acceptable documentation usually includes:

• A physician note describing the fracture as healed in a malunited or malpositioned state
• A radiology report confirming union with angular deformity, rotational malalignment, or shortening
• Clinical findings consistent with symptomatic malunion, such as persistent pain, functional limitation, or gait change, supported by imaging

When you query the physician, ask specifically whether imaging confirms healing in a non-anatomical position. Vague wording like healing poorly or not improving does not support malunion.

It could equally point to delayed healing (character G) or nonunion (character K). Systematic denial management on musculoskeletal codes depends on tight documentation-to-code alignment.

When to use S92.354P vs related fifth metatarsal fracture codes

Three axes separate S92.354P from its neighbors in the S92.35 family. They are displacement, laterality, and the stage of care. The table below runs the common follow-up scenarios against each one.

The displaced versus nondisplaced call belongs to the treating clinician and the imaging, not to the coder. Where the record is silent on displacement, ICD-10-CM instructs coders to default to displaced. The displaced code then applies until the record is clarified. Billing teams working in software built for coders can flag incomplete displacement documentation before the claim goes out.

MS-DRG assignment for S92.354P

On an inpatient claim, S92.354P groups to one of three musculoskeletal MS-DRGs. Which one applies depends on whether a complication or comorbidity is also reported.

Most malunion follow-ups happen in the outpatient setting, so the MS-DRG rarely drives payment for this code. It matters when the malunion is corrected during an inpatient stay. The grouping above reflects MS-DRG v43.0, and S92.354P is exempt from present-on-admission reporting.

Approximate synonyms and alternate clinical descriptions

Clinicians and referral sources describe the same injury in different words. The terms below are the approximate synonyms and common clinical phrasings that map to ICD-10 Code S92.354P. Knowing them helps coders match documentation language to the code before a claim is built.

• Nondisplaced fifth metatarsal fracture, right foot, subsequent encounter with malunion
• Malunited nondisplaced fracture of the right fifth metatarsal
• Nondisplaced fracture, base of right fifth metatarsal, follow-up with malunion
• Right fifth metatarsal styloid fracture, nondisplaced, malunion encounter
• Dancer fracture of the right foot, healed in malposition
• Nondisplaced pseudo-Jones fracture, right foot, subsequent encounter with malunion

ICD-10-CM does not split the fifth metatarsal by fracture zone. A styloid avulsion in zone 1, a Jones fracture in zone 2, and a shaft fracture all route to the S92.35- codes. The coder decides on displacement, laterality and encounter stage instead.

Labels like dancer fracture and pseudo-Jones fracture are clinical shorthand, so read the imaging report for the details that drive the code. The wider ICD-10-CM code index covers the neighboring fracture families a foot and ankle coder works through in the same session.

Claim submission for S92.354P: Pabau and Claim.MD

Accurate coding is only half the billing equation. The claim still has to reach the payer, clear eligibility, and return an ERA before the practice sees revenue. Practice management software like Pabau integrates with the Claim.MD clearinghouse to support ICD-10-CM coded claim submission across thousands of US payers. That includes CMS-1500 and 837P electronic claims for musculoskeletal diagnoses such as S92.354P.

The integration covers real-time eligibility verification before the appointment, electronic remittance advice processing after adjudication, and CARC denial reason tracking. Orthopedic and sports medicine practices run high volumes of fracture follow-up visits, so catching eligibility issues before the visit cuts rework sharply.

Tracking denial patterns by diagnosis code shows which fracture codes keep coming back. Claim validation also confirms that ICD-10 codes pair correctly with the CPT codes billed on the same encounter.

The Claim.MD integration in Pabau also supports secondary and corrected claims. Those come up often when a malunion encounter goes out with thin documentation and is resubmitted with a physician addendum.

Streamline ICD-10 claim submission with Pabau

Pabau integrates with Claim.MD to support ICD-10-coded claim submission across thousands of US payers. From real-time eligibility checks to ERA processing, manage your billing workflow in one place.

Book a demo

Conclusion

S92.354P is only as good as the note behind it. Confirm three things in the record before you submit. Imaging has to show union in an abnormal position. The note has to name the right foot and describe the fracture as nondisplaced.

The 7th character carries more denial risk than the base code, because a payer can check it against the imaging report. So query the physician when healing status is ambiguous, instead of picking the character that fits the visit best.

Pabau’s claims management workflow, integrated with the Claim.MD clearinghouse, flags coding and eligibility problems before a malunion claim goes out. Book a demo to see how the ICD-10 catalog and denial tracking work on a fracture claim.

Continue your research

Checking that ICD-10 and CPT codes pair up? Clean claim sets out what has to line up on a claim before it reaches the payer.

Exploring clearinghouse options? Medical claims clearinghouse guide explains how clearinghouses fit into the revenue cycle and what to look for when evaluating one.

Reconciling payments after adjudication? Electronic remittance advice shows how to read an ERA and match it back to the claim you submitted.

Frequently asked questions