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ICD-10 Guide
ICD-10 CodesS82.199

S82.199

Billable

Other fracture of upper end of unspecified tibia

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/26/2025

Code Description

ICD-10 S82.199 is a billable code used to indicate a diagnosis of other fracture of upper end of unspecified tibia.

Key Diagnostic Point:

The code S82.199 refers to fractures occurring at the upper end of the tibia, which is the larger of the two bones in the lower leg. These fractures can result from various mechanisms, including trauma from falls, sports injuries, or vehicular accidents. The upper end of the tibia is critical for knee stability and function, as it articulates with the femur and forms part of the knee joint. Fractures in this area can lead to significant complications, including joint instability, malunion, or nonunion, which may necessitate surgical intervention. Symptoms typically include pain, swelling, and difficulty bearing weight on the affected leg. Diagnosis is often confirmed through imaging studies such as X-rays or MRI, which can also help assess any associated ligamentous injuries, such as tears to the anterior cruciate ligament (ACL) or medial collateral ligament (MCL). Treatment may involve conservative management with immobilization or surgical options like internal fixation or orthopedic reconstructive procedures, depending on the fracture's severity and associated injuries.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the upper tibia.
  • Potential for associated ligament injuries that complicate diagnosis.
  • Need for precise documentation of fracture details and treatment plans.
  • Differentiation from other tibial and fibular fractures.

Audit Risk Factors

  • Inadequate documentation of fracture specifics.
  • Failure to document associated injuries or complications.
  • Incorrect coding of laterality or fracture type.
  • Lack of clarity in treatment plans or follow-up care.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes.

Common Clinical Scenarios

Fractures due to sports injuries, falls, or vehicular accidents requiring surgical intervention.

Billing Considerations

Ensure accurate description of fracture type, location, and any associated ligament injuries.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional status and rehabilitation plans.

Common Clinical Scenarios

Post-operative rehabilitation following tibial fracture repair.

Billing Considerations

Document progress and any complications during rehabilitation.

Coding Guidelines

Inclusion Criteria

Use S82.199 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of fracture type, laterality, and any associated injuries

Exclusion Criteria

Do NOT use S82.199 When
  • Exclude codes for fractures that are more specific or have been previously documented

Related ICD-10 Codes

Related CPT Codes

27405CPT Code

Arthroscopy, knee, surgical; with meniscectomy (medial or lateral)

Clinical Scenario

Used in conjunction with S82.199 when a meniscal tear is identified during surgery.

Documentation Requirements

Operative report detailing the findings and procedures performed.

Specialty Considerations

Orthopedic surgeons should ensure clear documentation of all findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S82.199 provides a broader classification that can capture various fracture types at the upper end of the tibia.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S82.199 provides a broader classification that can capture various fracture types at the upper end of the tibia.

Reimbursement & Billing Impact

reimbursement processes. S82.199 provides a broader classification that can capture various fracture types at the upper end of the tibia.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between S82.199 and S82.10?

S82.199 is used for unspecified fractures of the upper end of the tibia, while S82.10 specifies a fracture of the upper end of the right tibia. Accurate coding requires documentation of laterality.