Fracture ICD-10 Codes: Complete Guide to Traumatic Fractures and 7th Character Extensions
- Jan 31, 2025
Fracture coding in ICD-10-CM is one of the most complex areas due to the required specificity for anatomical site, fracture type, laterality, and healing status. The key question is which body region and what's the healing status: skull/face → S02, neck → S12, thorax → S22, lumbar spine → S32, shoulder/arm → S42, forearm → S52, wrist/hand → S62, femur → S72, lower leg → S82, foot → S92. Every traumatic fracture requires a 7th character (A=initial, B/C=open, D=routine healing, G=delayed, K=nonunion, P=malunion, S=sequela). Pathological fractures use M codes, not S codes. External cause codes required for mechanism of injury.
Code Families
The 7th Character System — The 7th character is REQUIRED for all traumatic fracture codes and indicates the episode of care and healing status:
| Character | Description | When to Use |
|---|---|---|
| A | Initial encounter | Any visit for active fracture treatment (ED, office, surgery) |
| B | Initial, open type I/II | Open fracture, Gustilo type I or II |
| C | Initial, open type IIIA/B/C | Open fracture, Gustilo type III |
| D | Subsequent, routine healing | Follow-up, normal healing |
| G | Subsequent, delayed healing | Healing slower than expected |
| K | Subsequent, nonunion | Fracture not healing |
| P | Subsequent, malunion | Healed in abnormal position |
| S | Sequela | Late effects/complications |
Key point: "A" is used for any initial encounter where active treatment is provided — ED visits, first office visits, and initial surgical treatment. A first orthopedic office visit also uses "A". When the fracture code has fewer than 7 characters, use "X" as a placeholder to reach the 7th position (e.g., S06.0X0A).
Clavicle fractures S42 — Most common shoulder fracture. Coded by location: sternal end S42.011A/S42.012A, shaft S42.021A, acromial end S42.031A/S42.032A. Right/left specificity required.
Forearm fractures S52 — Most common fall-related fractures. Named fracture types: Colles S52.531A/S52.532A (distal radius, dorsal displacement), Smith S52.541A (distal radius, volar displacement), Monteggia S52.271A (ulna shaft + radial head dislocation), Galeazzi S52.371A (radius shaft + distal ulna dislocation). For unspecified distal radius fractures, use S52.501A (right) or S52.502A (left).
Hip fractures S72 — Critical in elderly patients. Intracapsular (femoral neck, S72.001A-S72.009A) carry higher risk of avascular necrosis. Intertrochanteric (S72.101A-S72.109A) generally have better blood supply. S72.301A covers femoral shaft fractures.
Ankle fractures S82 — Coded by malleolus involved: medial S82.51XA/S82.52XA, lateral S82.61XA/S82.62XA, bimalleolar S82.841A/S82.842A, trimalleolar S82.851A.
Other body regions — Skull/Face S02, Cervical Spine S12, Thorax S22, Lumbar/Pelvis S32. Many codes require site specificity: cervical (C1-C7), thoracic (T1-T12), lumbar (L1-L5), lumbosacral, sacral/sacrococcygeal.
Pathological vs Traumatic — Pathological fractures from disease (osteoporosis, cancer) use M codes, not S codes. Example: M80.08XA for osteoporotic vertebral compression. Stress fractures use M84.3- codes (e.g., M84.361A for right tibia stress fracture).
External Cause Codes — Traumatic fractures require external cause code for mechanism. Common fall codes: W01.0XXA (slipping), W06.XXXA (from bed), W10.0XXA (from stairs), W19.XXXA (unspecified fall).
Coding Scenarios
Initial visit — closed fracture — Fall from standing height, XR right wrist shows closed distal radius fracture, splinted. Code S52.501A. The 7th character "A" applies to any visit where active treatment is provided — not just the ED. A first orthopedic office visit also uses "A".
Follow-up — routine healing — Right wrist fracture at 6 weeks, XR shows routine healing, continue cast. Code S52.501D. Switch from "A" (initial) to "D" (subsequent) once active treatment phase ends and follow-up/healing phase begins.
Hip fracture in elderly patient — 82 y/o female, fall at home, XR shows intertrochanteric fracture right femur, admitted for ORIF. Code S72.101A + W19.XXXA. Fractures require external cause code to identify mechanism of injury.
Open fracture — Compound fracture left tibia shaft, bone protruding through skin, Gustilo type II, taken to OR. Code S82.202B. The 7th character "B" is for open fractures Gustilo type I or II; use "C" for type IIIA, IIIB, or IIIC.
Delayed healing — Right clavicle fracture at 12 weeks, XR shows delayed union, no callus formation, bone stimulator ordered. Code S42.001G. "G" indicates delayed healing — the fracture is progressing but slower than expected.
Nonunion — Right tibial shaft fracture 8 months ago, XR confirms nonunion, surgical intervention planned. Code S82.201K. "K" indicates nonunion — the fracture has stopped healing and will not unite without intervention. Distinct from "G" (delayed healing, still progressing).
Malunion — Left ankle fracture from prior year, healed with valgus malalignment, presenting for corrective osteotomy. Code S82.62XP. "P" indicates malunion — the fracture healed but in an abnormal position.
Pathological fracture — Vertebral compression fracture due to osteoporosis, no trauma history, DEXA T-score -3.2. Code M80.08XA. Pathological fractures use M codes (Chapter 13), not S codes.
FAQ
What does the 7th character "A" mean? Initial encounter — the first visit when the patient is receiving active treatment for the fracture. This applies to ED visits, first office visits, and initial surgical treatment.
What does the 7th character "D" mean? Subsequent encounter for routine healing — follow-up visits after initial treatment where the fracture is healing normally.
When do I use "G" vs "K" vs "P"? "G" (delayed healing) = fracture taking longer than expected to heal. "K" (nonunion) = fracture is not healing and won't heal without intervention. "P" (malunion) = fracture healed in an abnormal position.
Is "A" only for the emergency department? No. "A" is used for any initial encounter where active treatment is being provided. This includes the first orthopedic office visit, even if the patient was seen in the ED previously for the same fracture.
What if laterality is not documented? Use the "unspecified" side code (usually digit 0 or 9 in the laterality position). Query the provider when possible for better specificity.
How do I code a stress fracture? Stress fractures use M84.3- codes (Chapter 13), not traumatic fracture codes. Example: M84.361A for stress fracture, right tibia, initial encounter.
Search fracture codes · Chapter 19: Injury · Hip fractures (S72) · Forearm fractures (S52) · Stress fractures (M84) · AI Analyzer