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. This guide covers traumatic fracture codes in Chapter 19 (S00-T88), the critical 7th character extensions, and common orthopedic coding scenarios.
Quick Reference: Fracture Code Categories by Body Region
| Body Region | Code Range | Common Fractures |
|---|---|---|
| Skull/Face | S02 | Skull fractures, facial bones |
| Neck | S12 | Cervical vertebra fractures |
| Thorax | S22 | Rib, sternum, thoracic spine |
| Lumbar Spine | S32 | Lumbar vertebra, pelvis |
| Shoulder/Arm | S42 | Clavicle, scapula, humerus |
| Forearm | S52 | Radius, ulna |
| Wrist/Hand | S62 | Carpal, metacarpal, phalanges |
| Femur | S72 | Hip, femoral shaft |
| Lower Leg | S82 | Tibia, fibula, ankle |
| Foot | S92 | Tarsal, metatarsal, toes |
Understanding the 7th Character Extension
The 7th character is REQUIRED for all traumatic fracture codes. It indicates the episode of care and healing status.
7th Character Options for Fractures
| Character | Description | When to Use |
|---|---|---|
| A | Initial encounter | First visit for active fracture treatment |
| B | Initial encounter, open fracture type I/II | Open fracture, Gustilo type I or II |
| C | Initial encounter, open fracture type IIIA/B/C | Open fracture, Gustilo type III |
| D | Subsequent encounter, routine healing | Follow-up, normal healing |
| G | Subsequent encounter, delayed healing | Healing slower than expected |
| K | Subsequent encounter, nonunion | Fracture not healing |
| P | Subsequent encounter, malunion | Healed in abnormal position |
| S | Sequela | Late effects/complications |
Important: Not all fracture codes use all 7th characters. Some use only A, D, and S.
Placeholder X
When the fracture code has fewer than 7 characters, use 'X' as a placeholder to reach the 7th character position.
Example: S06.0X0A (Concussion without loss of consciousness, initial encounter)
S42: Shoulder and Upper Arm Fractures
The S42 category covers clavicle, scapula, and humerus fractures.
Common S42 Codes
| Code | Description |
|---|---|
| S42.001A | Fracture of unspecified part of right clavicle, initial |
| S42.002A | Fracture of unspecified part of left clavicle, initial |
| S42.021A | Displaced fracture of shaft of right clavicle, initial |
| S42.201A | Unspecified fracture of upper end of right humerus, initial |
| S42.301A | Unspecified fracture of shaft of right humerus, initial |
| S42.401A | Unspecified fracture of lower end of right humerus, initial |
Clavicle Fracture Coding
| Fracture Location | Right Side | Left Side |
|---|---|---|
| Sternal end | S42.011A | S42.012A |
| Shaft | S42.021A-S42.026A | S42.022A-S42.026A |
| Acromial end | S42.031A | S42.032A |
S52: Forearm Fractures
The S52 category covers radius and ulna fractures, common in falls.
Common Forearm Fracture Types
| Fracture Type | Code Range | Description |
|---|---|---|
| Colles fracture | S52.531A-S52.532A | Distal radius with dorsal displacement |
| Smith fracture | S52.541A-S52.542A | Distal radius with volar displacement |
| Monteggia | S52.271A-S52.272A | Ulna shaft with radial head dislocation |
| Galeazzi | S52.371A-S52.372A | Radius shaft with distal ulna dislocation |
| Radial head | S52.121A-S52.129A | Fracture of radial head |
Distal Radius Fractures (Wrist)
| Code | Description |
|---|---|
| S52.501A | Unspecified fracture of lower end of right radius, initial |
| S52.502A | Unspecified fracture of lower end of left radius, initial |
| S52.531A | Colles fracture of right radius, initial |
| S52.532A | Colles fracture of left radius, initial |
S72: Femur Fractures
The S72 category covers hip and femoral shaft fractures, critical in elderly patients.
Hip Fracture Codes
| Code | Description |
|---|---|
| S72.001A | Fracture of unspecified part of neck of right femur, initial |
| S72.002A | Fracture of unspecified part of neck of left femur, initial |
| S72.011A | Unspecified intracapsular fracture of right femur, initial |
| S72.021A | Displaced fracture of epiphysis of right femur, initial |
| S72.101A | Unspecified trochanteric fracture of right femur, initial |
| S72.301A | Unspecified fracture of shaft of right femur, initial |
Intertrochanteric vs Intracapsular
Intracapsular (femoral neck): Higher risk of avascular necrosis
- S72.001A-S72.009A (unspecified neck)
- S72.011A-S72.019A (intracapsular)
Intertrochanteric: Usually better blood supply
- S72.101A-S72.109A (unspecified trochanteric)
- S72.111A-S72.119A (intertrochanteric)
S82: Lower Leg Fractures
The S82 category covers tibia, fibula, and ankle fractures.
Common Ankle Fractures
| Code | Description |
|---|---|
| S82.51XA | Displaced fracture of medial malleolus of right tibia, initial |
| S82.52XA | Displaced fracture of medial malleolus of left tibia, initial |
| S82.61XA | Displaced fracture of lateral malleolus of right fibula, initial |
| S82.62XA | Displaced fracture of lateral malleolus of left fibula, initial |
| S82.841A | Displaced bimalleolar fracture of right lower leg, initial |
| S82.842A | Displaced bimalleolar fracture of left lower leg, initial |
| S82.851A | Displaced trimalleolar fracture of right lower leg, initial |
Common Coding Scenarios
Scenario 1: Initial Visit for Closed Fracture
Documentation: Patient fell, x-ray shows closed distal radius fracture, right wrist. First visit. Code: S52.501A - Unspecified fracture of lower end of right radius, initial encounter for closed fracture
Scenario 2: Follow-up Visit with Routine Healing
Documentation: Patient returns for follow-up of right wrist fracture. X-ray shows routine healing. Code: S52.501D - Unspecified fracture of lower end of right radius, subsequent encounter for closed fracture with routine healing
Scenario 3: Hip Fracture in Elderly
Documentation: 82-year-old with intertrochanteric fracture of right femur after fall. Codes:
- S72.101A - Unspecified trochanteric fracture of right femur, initial
- W19.XXXA - Unspecified fall, initial encounter (external cause)
Scenario 4: Open Fracture
Documentation: Compound fracture of left tibia shaft with bone protruding through skin, Gustilo type II. Code: S82.202B - Unspecified fracture of shaft of left tibia, initial encounter for open fracture type I or II
Scenario 5: Fracture with Delayed Healing
Documentation: Follow-up for right clavicle fracture, x-ray shows delayed union at 12 weeks. Code: S42.001G - Fracture of unspecified part of right clavicle, subsequent encounter for fracture with delayed healing
Scenario 6: Nonunion (Not Healing)
Documentation: Right tibial fracture from 8 months ago, now shows nonunion. Code: S82.201K - Unspecified fracture of shaft of right tibia, subsequent encounter for closed fracture with nonunion
Scenario 7: Malunion
Documentation: Previous left ankle fracture, now healed with malalignment. Code: S82.62XP - Displaced fracture of lateral malleolus of left fibula, subsequent encounter for closed fracture with malunion
Scenario 8: Pathological Fracture
Documentation: Vertebral fracture due to osteoporosis. Code: M80.08XA - Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter
Note: Pathological fractures use M codes (Chapter 13), not S codes.
External Cause Codes (W00-W19)
Fractures require external cause codes to identify how the injury occurred:
| Code | Description |
|---|---|
| W01.0XXA | Fall on same level from slipping, initial |
| W06.XXXA | Fall from bed, initial |
| W10.0XXA | Fall from stairs, initial |
| W19.XXXA | Unspecified fall, initial |
Frequently Asked Questions
What does the 7th character "A" mean?
The 7th character "A" indicates 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?
The 7th character "D" indicates 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.
Can I use subsequent encounter codes in the ED?
Rarely. If a patient returns to the ED specifically for follow-up of a healing fracture (not new treatment), a subsequent encounter code could apply. But most ED visits involve active treatment and use initial encounter codes.
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 - Stress fracture, right tibia, initial encounter.
Related Resources
- Search fracture codes
- Browse Chapter 19: Injury
- Hip fracture codes (S72)
- Wrist fracture codes (S62)
- Pathological fracture codes (M84)
- AI Clinical Note Analyzer - Extract fracture codes from clinical notes
Last updated: January 2025. Code data reflects ICD-10-CM 2026 version.