ICD-10 Coding for Distal Fibula Fracture(S82.641A, S82.642A)
Complete ICD-10-CM coding and documentation guide for Distal Fibula Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Distal Fibula Fracture
S82.6-S82.8Primary Range
Fractures of the fibula
This range includes specific codes for fractures of the fibula, including the distal fibula, which is the focus of this documentation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S82.641A | Nondisplaced fracture of lateral malleolus of right fibula, initial encounter for closed fracture | Use when a nondisplaced fracture of the right lateral malleolus is confirmed and documented. |
|
| S82.642A | Nondisplaced fracture of lateral malleolus of left fibula, initial encounter for closed fracture | Use when a nondisplaced fracture of the left lateral malleolus is confirmed and documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for right distal fibula fracture
Essential facts and insights about Distal Fibula Fracture
Primary ICD-10-CM Codes for distal fibula fracture
Decision Criteria
clinical Criteria
- Confirmed nondisplaced fracture on X-ray
documentation Criteria
- Documentation specifies 'nondisplaced' and 'right lateral malleolus'
Applicable To
- Nondisplaced fracture of right lateral malleolus
Excludes
- Open fracture of lateral malleolus
Clinical Validation Requirements
- X-ray confirmation of nondisplaced fracture
- No open wound
Code-Specific Risks
- Misclassification if displacement is not specified
Coding Notes
- Ensure laterality and displacement are clearly documented.
S82.642A - Nondisplaced fracture of lateral malleolus of left fibula, initial encounter for closed fracture
Use when a nondisplaced fracture of the left lateral malleolus is confirmed and documented.
Applicable To
- Nondisplaced fracture of left lateral malleolus
Excludes
- Open fracture of lateral malleolus
Clinical Validation Requirements
- X-ray confirmation of nondisplaced fracture
- No open wound
Coding Notes
Ensure laterality and displacement are clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Periprosthetic fracture around ankle prosthesis
M97.3XKADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Distal Fibula Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S82.641A.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient detail.
Mitigation Strategy
Always document laterality in the initial assessment., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases the accuracy of medical records.
Mitigation Strategy
Always specify the fracture type and laterality in documentation.
Impact
Audits may focus on the specificity of fracture documentation, particularly regarding displacement and laterality.
Mitigation Strategy
Use detailed templates and verify documentation against imaging findings.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Distal Fibula Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Distal Fibula Fracture
Use these documentation templates to ensure complete and accurate documentation for Distal Fibula Fracture. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of distal fibula fracture
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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